Provider Demographics
NPI:1154998870
Name:SMERCHEK, KYLIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:SMERCHEK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4700 MORTENSEN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-5580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4700 MORTENSEN RD STE 101
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-5580
Practice Address - Country:US
Practice Address - Phone:515-337-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA107023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA107023OtherPHYSICAL THERAPY LICENSE