Provider Demographics
NPI:1760949283
Name:LEMARR, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:LEMARR
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 1:1327 TROUP HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4443
Mailing Address - Country:US
Mailing Address - Phone:903-606-8400
Mailing Address - Fax:
Practice Address - Street 1:271 RSCR 4269
Practice Address - Street 2:
Practice Address - City:EMORY
Practice Address - State:TX
Practice Address - Zip Code:75440-3663
Practice Address - Country:US
Practice Address - Phone:573-281-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT67872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer