Provider Demographics
NPI:1124454541
Name:LYLE, RUTH ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ELIZABETH
Last Name:LYLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 ASPEN HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-1111
Mailing Address - Country:US
Mailing Address - Phone:907-388-0692
Mailing Address - Fax:
Practice Address - Street 1:315 BARNETTE ST
Practice Address - Street 2:#74638
Practice Address - City:FARIBANKS
Practice Address - State:AK
Practice Address - Zip Code:99707-4638
Practice Address - Country:US
Practice Address - Phone:907-388-0692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist