Provider Demographics
NPI:1912204819
Name:BYLES, KRISTEN SUZANNE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SUZANNE
Last Name:BYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 RUNNERS WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5408
Mailing Address - Country:US
Mailing Address - Phone:954-383-1744
Mailing Address - Fax:
Practice Address - Street 1:1809 RUNNERS WAY
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-5408
Practice Address - Country:US
Practice Address - Phone:954-383-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 45818225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist