Provider Demographics
NPI:1124273172
Name:LYDON, MICHELE M (MPT)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:M
Last Name:LYDON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WRIGHT PL
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5309
Mailing Address - Country:US
Mailing Address - Phone:845-671-1830
Mailing Address - Fax:
Practice Address - Street 1:7 WRIGHT PL
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5309
Practice Address - Country:US
Practice Address - Phone:845-671-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015107225100000X
NJ40 QAO7311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist