Provider Demographics
NPI:1780096974
Name:KYLE M HIERHOLZER LMT
Entity type:Organization
Organization Name:KYLE M HIERHOLZER LMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIERHOLZER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:315-569-4549
Mailing Address - Street 1:99 E ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2717
Mailing Address - Country:US
Mailing Address - Phone:315-569-4549
Mailing Address - Fax:
Practice Address - Street 1:99 E ONEIDA ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2717
Practice Address - Country:US
Practice Address - Phone:315-569-4549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025375225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty