Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 855 | RI |
NPI | 1366863912 |
---|---|
Provider Name | Mrs. Karen George Lyles |
First Address | Cumberland, RI 02864-4617 |
Second Address | Cumberland, RI 02864-4617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2013 |
Last Update Date | 29/12/2013 |