Provider Demographics
NPI:1316494230
Name:MORGAN, LYLE EDWARD (PTA)
Entity type:Individual
Prefix:MR
First Name:LYLE
Middle Name:EDWARD
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:92 MONTVALE AVE
Mailing Address - Street 2:1100
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3647
Mailing Address - Country:US
Mailing Address - Phone:781-279-8433
Mailing Address - Fax:781-279-8436
Practice Address - Street 1:92 MONTVALE AVE
Practice Address - Street 2:1100
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3647
Practice Address - Country:US
Practice Address - Phone:781-279-8433
Practice Address - Fax:781-279-8436
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA8201225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant