Healthcare Provider Details

I. General information

NPI: 1710615257
Provider Name (Legal Business Name): MICHAELA LYLE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W BEEBE CAPPS EXPY
SEARCY AR
72143-6353
US

IV. Provider business mailing address

801 W BEEBE CAPPS EXPY
SEARCY AR
72143-6353
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-2513
  • Fax: 501-279-1328
Mailing address:
  • Phone: 501-268-2513
  • Fax: 501-279-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5174
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: