Provider Demographics
NPI:1124896204
Name:LYLES, LEKISHA BRIONNA
Entity type:Individual
Prefix:
First Name:LEKISHA
Middle Name:BRIONNA
Last Name:LYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14827 PRESTON RD APT 1101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9119
Mailing Address - Country:US
Mailing Address - Phone:682-333-3839
Mailing Address - Fax:
Practice Address - Street 1:14827 PRESTON RD APT 1101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-9119
Practice Address - Country:US
Practice Address - Phone:682-333-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2134317225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant