Basic Information
| Provider Information | |||||||||
| NPI: | 1003187972 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAYHEART | ||||||||
| FirstName: | KYLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3345 STATE ROUTE 746 | ||||||||
| Address2: | |||||||||
| City: | CARDINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433159755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143380795 | ||||||||
| FaxNumber: | 6143380827 | ||||||||
| Practice Location | |||||||||
| Address1: | 1151 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432092827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143380795 | ||||||||
| FaxNumber: | 6143380827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 01/24/2012 | ||||||||
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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 | 225200000X | 07033 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.