Provider Demographics
NPI:1821545120
Name:MURRAY, KYLE PATRICK (MED, ATC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:PATRICK
Last Name:MURRAY
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 HIGHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-1417
Mailing Address - Country:US
Mailing Address - Phone:203-517-6959
Mailing Address - Fax:
Practice Address - Street 1:1 COLLEGE ROAD
Practice Address - Street 2:
Practice Address - City:HAMPDEN-SYDNEY
Practice Address - State:VA
Practice Address - Zip Code:23943
Practice Address - Country:US
Practice Address - Phone:434-223-6843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260023722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer