Provider Demographics
NPI:1780093948
Name:MARTIN, KYLE (PT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MARTIN
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 1:2001 MALLORY LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8233
Mailing Address - Country:US
Mailing Address - Phone:615-373-9461
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:1680 UNION AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3768
Practice Address - Country:US
Practice Address - Phone:901-969-0297
Practice Address - Fax:901-969-0198
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist