Provider Demographics
NPI:1427125723
Name:LYONS, EDWARD J (PT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:LYONS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4028
Mailing Address - Country:US
Mailing Address - Phone:410-795-7696
Mailing Address - Fax:470-795-5789
Practice Address - Street 1:1912 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6602
Practice Address - Country:US
Practice Address - Phone:410-795-7696
Practice Address - Fax:410-795-5789
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT4730002OtherGHMSI
MD60850502OtherCAREFIRST MARYLAND
MD7295156OtherAETNA
MD2126696OtherMAMSI
MD3584226OtherAETNA
MDH25853Medicare UPIN
MD3584226OtherAETNA
MD60850502OtherCAREFIRST MARYLAND