Provider Demographics
NPI:1801100193
Name:MILLER, KYLE PAUL (DPT, ATC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:PAUL
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:945 E HAVERFORD RD FL 1
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3814
Mailing Address - Country:US
Mailing Address - Phone:610-525-1223
Mailing Address - Fax:610-525-5797
Practice Address - Street 1:27 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3406
Practice Address - Country:US
Practice Address - Phone:610-672-1163
Practice Address - Fax:610-527-1501
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist