Provider Demographics
NPI:1063938207
Name:LYMAN, GEORGE MINGES (MOT,OTR)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MINGES
Last Name:LYMAN
Suffix:
Gender:M
Credentials:MOT,OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 JOY DIANNE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4853
Mailing Address - Country:US
Mailing Address - Phone:214-986-6673
Mailing Address - Fax:
Practice Address - Street 1:512 JOY DIANNE DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4853
Practice Address - Country:US
Practice Address - Phone:214-986-6673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist