Provider Demographics
NPI:1194086793
Name:POWER, KYLE B (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:B
Last Name:POWER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 MANGUM ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75428-3515
Mailing Address - Country:US
Mailing Address - Phone:903-886-7669
Mailing Address - Fax:903-886-7679
Practice Address - Street 1:4101 WESLEY ST
Practice Address - Street 2:SUITE H
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5635
Practice Address - Country:US
Practice Address - Phone:903-454-8100
Practice Address - Fax:903-454-1180
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3111821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141625702Medicaid
TX676522OtherMEDICARE - GROUP NUMBER