Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT22244 | FL |
N | 225XH1200X | Occupational Therapist - Hand | OT10086 | FL |
NPI | 1093730764 |
---|---|
Provider Name | Dr. Edward Douglas Lyle II |
First Address | St Augustine, FL 32092-1709 |
Second Address | Jacksonville, FL 32206-4382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |