Provider Demographics
NPI:1124239058
Name:KYLE, BRYAN A (PT CSCS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:A
Last Name:KYLE
Suffix:
Gender:M
Credentials:PT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-8227
Mailing Address - Country:US
Mailing Address - Phone:937-335-5001
Mailing Address - Fax:
Practice Address - Street 1:4801 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-1084
Practice Address - Country:US
Practice Address - Phone:937-236-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist