Provider Demographics
NPI:1891163317
Name:TAYLOR, KYLE RICHARD (CMT, MMT, MHT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:RICHARD
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:CMT, MMT, MHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N SUNRISE WAY APT 202
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-0305
Mailing Address - Country:US
Mailing Address - Phone:760-898-3641
Mailing Address - Fax:
Practice Address - Street 1:400 N SUNRISE WAY APT 202
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-0305
Practice Address - Country:US
Practice Address - Phone:760-898-3641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26687225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist