Provider Demographics
NPI:1710615257
Name:LYLE, MICHAELA (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:LYLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W BEEBE CAPPS EXPY
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6353
Mailing Address - Country:US
Mailing Address - Phone:501-268-2513
Mailing Address - Fax:501-279-1328
Practice Address - Street 1:801 W BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6353
Practice Address - Country:US
Practice Address - Phone:501-268-2513
Practice Address - Fax:501-279-1328
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT5174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist