Provider Demographics
NPI:1194955617
Name:LYONS, KAREN ANNE
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANNE
Last Name:LYONS
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 1:87 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3012
Mailing Address - Country:US
Mailing Address - Phone:617-773-7025
Mailing Address - Fax:
Practice Address - Street 1:804 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3055
Practice Address - Country:US
Practice Address - Phone:508-583-6000
Practice Address - Fax:508-427-7746
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8293225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant