Provider Demographics
NPI:1760836845
Name:KNAPP, KYLE (ATC, AT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:KNAPP
Suffix:
Gender:M
Credentials:ATC, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BECKET DR APT 3
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7402 WESTSHIRE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8988
Practice Address - Country:US
Practice Address - Phone:517-853-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010016222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer