Provider Demographics
NPI:1003187972
Name:GAYHEART, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:GAYHEART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 STATE ROUTE 746
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9755
Mailing Address - Country:US
Mailing Address - Phone:614-338-0795
Mailing Address - Fax:614-338-0827
Practice Address - Street 1:1151 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2827
Practice Address - Country:US
Practice Address - Phone:614-338-0795
Practice Address - Fax:614-338-0827
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07033225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant