Provider Demographics
NPI:1922307933
Name:DAVIDSON, KYLE MATTHEW (DPT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:MATTHEW
Last Name:DAVIDSON
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 1:8300 HEALTH PARK, SUITE 127
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-845-6160
Mailing Address - Fax:919-845-6188
Practice Address - Street 1:8300 HEALTH PARK, SUIE 127
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:919-845-6160
Practice Address - Fax:919-845-6188
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist