Provider Demographics
NPI:1386048817
Name:LACASSE, KYLE THOMAS (DPT)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:THOMAS
Last Name:LACASSE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2436
Mailing Address - Country:US
Mailing Address - Phone:578-444-1005
Mailing Address - Fax:085-285-4483
Practice Address - Street 1:425 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2063
Practice Address - Country:US
Practice Address - Phone:617-244-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty