Provider Demographics
NPI:1831727080
Name:MURPHY, KYLIE (ATC)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:CROFUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:19964 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-9474
Mailing Address - Country:US
Mailing Address - Phone:763-443-0767
Mailing Address - Fax:
Practice Address - Street 1:1550 3RD ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-3479
Practice Address - Country:US
Practice Address - Phone:763-443-0767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer