Individual
KYLE STREETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
319 BROADWAY, FORT EDWARD, NY 12828-1221
(518) 747-2811
Mailing address
49 OAK VIEW DR, FORT EDWARD, NY 12828-2205
(518) 321-9525
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
NY
Other
Enumeration date
07/08/2019
Last updated
07/08/2019
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