Provider Demographics
NPI:1205167897
Name:LASSITER, KYLE
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:LASSITER
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 1:295 E 29TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2743
Mailing Address - Country:US
Mailing Address - Phone:970-663-6142
Mailing Address - Fax:970-635-3087
Practice Address - Street 1:295 E 29TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2743
Practice Address - Country:US
Practice Address - Phone:970-663-6142
Practice Address - Fax:970-635-3087
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35469225100000X
CO10862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist