Provider Demographics
NPI:1972366276
Name:SCHLUETER, KYLE (LMT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SCHLUETER
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 1:2488 NANTUCKET CT NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2532
Mailing Address - Country:US
Mailing Address - Phone:505-717-5760
Mailing Address - Fax:
Practice Address - Street 1:4200 MEADOWLARK LN SE STE 3
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1050
Practice Address - Country:US
Practice Address - Phone:505-717-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT9137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist