Provider Demographics
NPI:1043503303
Name:CICERO, KYLE S (DPT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:S
Last Name:CICERO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 ROAD RUNNER ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0566
Mailing Address - Country:US
Mailing Address - Phone:406-513-1422
Mailing Address - Fax:406-513-1227
Practice Address - Street 1:665 ROAD RUNNER ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0566
Practice Address - Country:US
Practice Address - Phone:406-513-1422
Practice Address - Fax:406-513-1127
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist