Provider Demographics
NPI:1710443965
Name:LASHLEY, KYLE TAYLOR
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:TAYLOR
Last Name:LASHLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12514 BATTLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9692
Mailing Address - Country:US
Mailing Address - Phone:740-995-9020
Mailing Address - Fax:
Practice Address - Street 1:12514 BATTLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9692
Practice Address - Country:US
Practice Address - Phone:740-995-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer