Provider Demographics
NPI:1760025308
Name:BARR, KYLE ROBERT (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ROBERT
Last Name:BARR
Suffix:
Gender:M
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5878
Mailing Address - Country:US
Mailing Address - Phone:260-388-6806
Mailing Address - Fax:
Practice Address - Street 1:1428 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5878
Practice Address - Country:US
Practice Address - Phone:260-388-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer