Provider Demographics
NPI:1386985810
Name:LYONS, WESLEY (ATC/LAT)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:LYONS
Suffix:
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 PLEASANT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4310
Mailing Address - Country:US
Mailing Address - Phone:814-949-9500
Mailing Address - Fax:814-949-9550
Practice Address - Street 1:3200 PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4310
Practice Address - Country:US
Practice Address - Phone:814-949-9500
Practice Address - Fax:814-949-9550
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0051702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer