Provider Demographics
NPI:1689404204
Name:MILLER, KYLE DAVID
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DAVID
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 MEADOWVIEW TER S
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18092-2090
Mailing Address - Country:US
Mailing Address - Phone:267-987-2679
Mailing Address - Fax:
Practice Address - Street 1:6450 MEADOWVIEW TERR S
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18092
Practice Address - Country:US
Practice Address - Phone:267-987-2679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program