Provider Demographics
NPI:1881217826
Name:HADUCK, KYLIE FIELD (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:FIELD
Last Name:HADUCK
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 MAJESTIC OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-5506
Mailing Address - Country:US
Mailing Address - Phone:484-788-5209
Mailing Address - Fax:
Practice Address - Street 1:1400 SPRING GARDEN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27412-5015
Practice Address - Country:US
Practice Address - Phone:484-788-5209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-41702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer