Provider Demographics
NPI:1306251152
Name:PALERMO, KYLIE ANNE (DPT)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANNE
Last Name:PALERMO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:816-226-4011
Mailing Address - Fax:816-524-6115
Practice Address - Street 1:7932 N OAK TRFY
Practice Address - Street 2:STE 212
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-1423
Practice Address - Country:US
Practice Address - Phone:816-420-0286
Practice Address - Fax:816-420-8207
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04843225100000X
MO2014023633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50779012OtherBCBS-KC
MOMA4370080OtherMEDICARE PTAN
000857OtherOPTUM
KSKA2868060OtherMEDICARE PTAN
KSUSES NPIOtherBCBS-KANSAS