MEDICARE: MISS DAPHYNE CAMILLE LYLE PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2058862	TX

General Provider Information

NPI Number	:	1710153861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DAPHYNE CAMILLE LYLE PTA

Provider Business Mailing Address
First Line	:	2626 REAGAN ST
Second Line	:	315
City	:	DALLAS
State	:	TX
Zip	:	75219-3312
Country	:	US
Telephone Number	:	214-876-4229
Fax Number	:

Provider Business Practice Location Address
First Line	:	8050 MEADOW RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3406
Country	:	US
Telephone Number	:	469-523-2650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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