Active NPI
Kyle Andrew Lebarron, PT
- Physical Therapist
- Charleston, WV
National Provider Identifier
1104490853
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 003884
- Practice address
- 4216 Maccorkle Ave SE Ste 4
Charleston, WV 25304-2539 - Phone
- (304) 926-0913
- Fax
- (304) 926-0914
- NPI assigned
- May 18, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 003884 | WV | Primary |
Addresses
Primary practice location
4216 Maccorkle Ave SE Ste 4
Charleston, WV 25304-2539
Mailing address
4216 Maccorkle Ave SE Ste 4
Charleston, WV 25304-2539
Phone (304) 926-0913
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003884 | WV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621296000000",
"number": "1104490853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4216 MACCORKLE AVE SE STE 4",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253042539",
"telephone_number": "304-926-0913",
"fax_number": "304-926-0914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4216 MACCORKLE AVE SE STE 4",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253042539",
"telephone_number": "304-926-0913",
"fax_number": "304-926-0914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEBARRON",
"first_name": "KYLE",
"middle_name": "ANDREW",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-18",
"last_updated": "2021-05-18",
"certification_date": "2021-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "003884",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.