Provider Demographics
NPI:1306046479
Name:PROTHRO, KYLE JOSEPH (ATC)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:JOSEPH
Last Name:PROTHRO
Suffix:
Gender:M
Credentials:ATC
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Mailing Address - Street 1:2145 HENRY TECKLENBURG DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5893
Mailing Address - Country:US
Mailing Address - Phone:843-872-2720
Mailing Address - Fax:
Practice Address - Street 1:2145 HENRY TECKLENBURG DR
Practice Address - Street 2:SUITE 220
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5893
Practice Address - Country:US
Practice Address - Phone:843-872-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
050702214OtherNATABOC
SC1248OtherSCDHEC