Provider Demographics
NPI:1336883453
Name:LYON PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:LYON PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER/PT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:906-309-0185
Mailing Address - Street 1:2016 MAPLE AVE UNIT 1021
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4649
Mailing Address - Country:US
Mailing Address - Phone:906-309-0158
Mailing Address - Fax:906-299-5067
Practice Address - Street 1:N3116 S 1 DR
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:MI
Practice Address - Zip Code:49893-9627
Practice Address - Country:US
Practice Address - Phone:906-309-0158
Practice Address - Fax:906-299-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty