Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 10142 | CO |
NPI | 1023262748 |
---|---|
Provider Name | Stephanie Marie Lyle |
First Address | Littleton, CO 80163-0001 |
Second Address | Highlands Ranch, CO 80130-6928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2008 |
Last Update Date | 07/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | CO |