Provider Demographics
NPI:1215914957
Name:LYALL, CAROLINE A (PT)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:A
Last Name:LYALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2854 BELL ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1721
Mailing Address - Country:US
Mailing Address - Phone:740-454-6022
Mailing Address - Fax:
Practice Address - Street 1:2854 BELL ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1721
Practice Address - Country:US
Practice Address - Phone:740-454-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT9473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2550832Medicaid
CA1586OtherGROUP MEDICARE RAILROAD
OH000000383509OtherANTHEM PIN
OH0989499OtherGROUP MEDICAID
OH000000383509OtherANTHEM PIN
CA1586OtherGROUP MEDICARE RAILROAD