Provider Demographics
NPI:1053752303
Name:DAVIS, KYLE LYNN (ATC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 OAK RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-8175
Mailing Address - Country:US
Mailing Address - Phone:317-362-5168
Mailing Address - Fax:
Practice Address - Street 1:7001 W 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-9725
Practice Address - Country:US
Practice Address - Phone:317-808-5234
Practice Address - Fax:317-297-8086
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001862A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer