Provider Demographics
NPI:1013612662
Name:LYLE, JESSICA L (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:LYLE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1142
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-1142
Mailing Address - Country:US
Mailing Address - Phone:540-679-0312
Mailing Address - Fax:
Practice Address - Street 1:900 N GRAND AVE # 6A
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-4440
Practice Address - Country:US
Practice Address - Phone:903-813-2514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer