Healthcare Provider Details

I. General information

NPI: 1306236120
Provider Name (Legal Business Name): DONA LYTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2015
Last Update Date: 02/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 N DRAKE RD
KALAMAZOO MI
49006-1358
US

IV. Provider business mailing address

2575 N DRAKE RD
KALAMAZOO MI
49006-1358
US

V. Phone/Fax

Practice location:
  • Phone: 269-342-0206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502000749
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: