Provider Demographics
NPI:1215501028
Name:LYONS, BETH ANN (DPT)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:LYONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:BROESDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 N FREMONT ST STE B
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:IA
Mailing Address - Zip Code:50250-2083
Mailing Address - Country:US
Mailing Address - Phone:515-523-8049
Mailing Address - Fax:641-338-3809
Practice Address - Street 1:312 N FREMONT ST STE B
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:IA
Practice Address - Zip Code:50250-2083
Practice Address - Country:US
Practice Address - Phone:515-523-8049
Practice Address - Fax:641-332-3809
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100188225100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation