Individual
MR. KYLE JEFFREY KOSTYUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
399 FARMINGTON AVE, 3RD FLOOR, FARMINGTON, CT 06032-1936
(860) 284-0235
(860) 284-0221
Mailing address
221 HOLLISTER DR, AVON, CT 06001-2934
(813) 416-5546
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
010602021
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
995586
NATA MEMBER NUMBER
FL
Enumeration date
07/09/2006
Last updated
07/18/2017
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