Individual
KEITH EDWARD KYLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
430 HIGHWAY 56, CALICO ROCK, AR 72519-8852
(870) 701-5089
(870) 270-0896
Mailing address
PO BOX 2398, MOUNTAIN HOME, AR 72654-2398
(870) 701-5089
(870) 277-0896
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1604
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14547194
CAQH
—
01
—
PT1604
ARKANSAS STATE MEDICAL BOARD
AR
Enumeration date
10/22/2019
Last updated
10/22/2019
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