Provider Demographics
NPI:1295144376
Name:MURISON, KYLE (DPT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MURISON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53170-0610
Mailing Address - Country:US
Mailing Address - Phone:414-614-8778
Mailing Address - Fax:
Practice Address - Street 1:230 N WALWORTH AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-9201
Practice Address - Country:US
Practice Address - Phone:414-614-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12724-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist