Provider Demographics
NPI:1477015758
Name:LYLES, ROBERT WILIAM (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILIAM
Last Name:LYLES
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 PINION DR
Mailing Address - Street 2:
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-333-5055
Mailing Address - Fax:
Practice Address - Street 1:112 N RUBEY DR UNIT 135
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-3214
Practice Address - Country:US
Practice Address - Phone:303-279-7703
Practice Address - Fax:303-278-1037
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2024-10-07
Deactivation Date:2022-04-05
Deactivation Code:
Reactivation Date:2022-07-14
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
COPTL.0019684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer