Basic Information
| Provider Information | |||||||||
| NPI: | 1255757605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERRILL | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LAT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4251 LEGION RD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | HOPE MILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283486201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104290600 | ||||||||
| FaxNumber: | 9104290602 | ||||||||
| Practice Location | |||||||||
| Address1: | 4251 LEGION RD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | HOPE MILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283486201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104290600 | ||||||||
| FaxNumber: | 9104290602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2014 | ||||||||
| LastUpdateDate: | 03/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 1753 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.