Provider Demographics
NPI:1962905679
Name:VALERY, KYLE (CMT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:VALERY
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16590 YERMO CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3300
Mailing Address - Country:US
Mailing Address - Phone:619-400-7030
Mailing Address - Fax:
Practice Address - Street 1:10803 VISTA SORRENTO PKWY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2792
Practice Address - Country:US
Practice Address - Phone:619-400-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72728225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA72728OtherCERTIFIED MASSAGE THERAPIST