Provider Demographics
NPI:1154950814
Name:KAHL, KYLE S (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:S
Last Name:KAHL
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 ARAPAHOE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1377
Mailing Address - Country:US
Mailing Address - Phone:303-903-9419
Mailing Address - Fax:
Practice Address - Street 1:5603 ARAPAHOE AVE STE 5
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1377
Practice Address - Country:US
Practice Address - Phone:303-903-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00012992081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine