Provider Demographics
NPI:1235729864
Name:PERRY, KYLE GREGORY (LMT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:GREGORY
Last Name:PERRY
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 DUNCAN CIR
Mailing Address - Street 2:
Mailing Address - City:LOBELVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37097-3428
Mailing Address - Country:US
Mailing Address - Phone:615-720-8029
Mailing Address - Fax:
Practice Address - Street 1:80 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOBELVILLE
Practice Address - State:TN
Practice Address - Zip Code:37097-3276
Practice Address - Country:US
Practice Address - Phone:615-720-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist