Provider Demographics
NPI:1710153861
Name:LYLE, DAPHYNE CAMILLE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:DAPHYNE
Middle Name:CAMILLE
Last Name:LYLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 REAGAN ST
Mailing Address - Street 2:315
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3312
Mailing Address - Country:US
Mailing Address - Phone:214-876-4229
Mailing Address - Fax:
Practice Address - Street 1:8050 MEADOW RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3406
Practice Address - Country:US
Practice Address - Phone:469-523-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2058862225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant