Provider Demographics
NPI:1720309602
Name:RUTLEDGE, KYLE SCOTT (ATC)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:SCOTT
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 CONCORDIA LN
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1994
Mailing Address - Country:US
Mailing Address - Phone:330-353-6017
Mailing Address - Fax:
Practice Address - Street 1:4516 CONCORDIA LN
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-1994
Practice Address - Country:US
Practice Address - Phone:330-353-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL23482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer