Provider Demographics
NPI:1255757605
Name:SHERRILL, KYLE (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:SHERRILL
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 LEGION RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-6201
Mailing Address - Country:US
Mailing Address - Phone:910-429-0600
Mailing Address - Fax:910-429-0602
Practice Address - Street 1:4251 LEGION RD
Practice Address - Street 2:SUITE 107
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-6201
Practice Address - Country:US
Practice Address - Phone:910-429-0600
Practice Address - Fax:910-429-0602
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer