Active NPI
Edward Douglas Lyle II, DPT/MOT
- Physical Therapist
- Saint Johns, FL
National Provider Identifier
1093730764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT22244
- Practice address
- 1900 Village Glen Dr
Saint Johns, FL 32259-9241 - Phone
- (904) 687-3271
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hand Occupational Therapist | 225XH1200X | OT10086 | FL | |
| Physical Therapist | 225100000X | PT22244 | FL | Primary |
Addresses
Primary practice location
1900 Village Glen Dr
Saint Johns, FL 32259-9241
Mailing address
1900 Village Glen Dr
Saint Johns, FL 32259-9241
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT22244 | FL | MD | Physical Therapist |
| OT10086 | FL | MD | Hand Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736294400000",
"number": "1093730764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 VILLAGE GLEN DR",
"city": "SAINT JOHNS",
"state": "FL",
"postal_code": "322599241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 VILLAGE GLEN DR",
"city": "SAINT JOHNS",
"state": "FL",
"postal_code": "322599241",
"telephone_number": "904-687-3271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYLE",
"first_name": "EDWARD",
"middle_name": "DOUGLAS",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "DPT/MOT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-13",
"last_updated": "2025-01-08",
"certification_date": "2025-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "225XH1200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Hand",
"state": "FL",
"license": "OT10086",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT22244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Johns, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.