Provider Demographics
NPI:1831672955
Name:OLEARY, KYLE J
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:J
Last Name:OLEARY
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:W10540 WALKERS RD
Mailing Address - Street 2:
Mailing Address - City:HUMBIRD
Mailing Address - State:WI
Mailing Address - Zip Code:54746-8115
Mailing Address - Country:US
Mailing Address - Phone:715-533-2696
Mailing Address - Fax:
Practice Address - Street 1:11509 S FORTUNA RD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7857
Practice Address - Country:US
Practice Address - Phone:928-342-8767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist