Provider Demographics
NPI:1023746500
Name:LYTLE, CORAL ANNETTE (CMT)
Entity type:Individual
Prefix:MS
First Name:CORAL
Middle Name:ANNETTE
Last Name:LYTLE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W VISALIA RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1019
Mailing Address - Country:US
Mailing Address - Phone:559-592-7117
Mailing Address - Fax:559-592-7112
Practice Address - Street 1:511 W VISALIA RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1019
Practice Address - Country:US
Practice Address - Phone:559-592-7117
Practice Address - Fax:559-592-7112
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist