Most Relevant Information
Provider Data
| NPI Number: | 1003381823 |
| Provider Name: | KYLIE MARIE GAINEY LAT, ATC |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/08/2018 |
| Last Updated: | 04/06/2022 |
Provider Practice Location
130 S. RAZORBACK ROAD
FAYETTEVILLE
AR
72701
Practice Location Phone/Fax
| Phone: | 3173763250 |
| Fax: |
Provider Mailing Location
226 S HILL AVE APT 108
FAYETTEVILLE
AR
727015770
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |