Provider Demographics
NPI:1295172427
Name:ELLER, KYLE M (PT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:M
Last Name:ELLER
Suffix:
Gender:M
Credentials:PT
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 211
Mailing Address - Street 2:
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632-0211
Mailing Address - Country:US
Mailing Address - Phone:402-367-1250
Mailing Address - Fax:
Practice Address - Street 1:112 E 11TH ST
Practice Address - Street 2:
Practice Address - City:SCHUYLER
Practice Address - State:NE
Practice Address - Zip Code:68661-1937
Practice Address - Country:US
Practice Address - Phone:402-352-3592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist