Provider Demographics
NPI:1922234913
Name:MORAN, KYLE RICHARD (DPT)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:RICHARD
Last Name:MORAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 S CAGE BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6870
Mailing Address - Country:US
Mailing Address - Phone:956-783-7111
Mailing Address - Fax:956-783-7109
Practice Address - Street 1:6400 S CAGE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6870
Practice Address - Country:US
Practice Address - Phone:956-783-7111
Practice Address - Fax:956-783-7109
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11873432251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics