Provider Demographics
NPI:1922437953
Name:SHIREMAN, KYLE (LAT,ATC,CEAS)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:SHIREMAN
Suffix:
Gender:M
Credentials:LAT,ATC,CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 EVELYN DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17061-1258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 EVELYN DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1258
Practice Address - Country:US
Practice Address - Phone:717-692-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0050222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer