Provider Demographics
NPI:1275371817
Name:BISCH, KYLE EVERETT (LMT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:EVERETT
Last Name:BISCH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 NW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4188
Mailing Address - Country:US
Mailing Address - Phone:360-836-4871
Mailing Address - Fax:
Practice Address - Street 1:11000 NW 14TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4188
Practice Address - Country:US
Practice Address - Phone:360-836-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61328621225700000X
OR28710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist