Provider Demographics
NPI:1922323823
Name:LYLE, SHANDA KRISTEN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:SHANDA
Middle Name:KRISTEN
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 1:1225 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-3829
Mailing Address - Country:US
Mailing Address - Phone:432-661-2592
Mailing Address - Fax:
Practice Address - Street 1:1225 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-3829
Practice Address - Country:US
Practice Address - Phone:432-661-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0606225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant