Provider Demographics
NPI:1720656887
Name:LYONS, KALIEE BROOKE (DPT)
Entity type:Individual
Prefix:
First Name:KALIEE
Middle Name:BROOKE
Last Name:LYONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-1410
Mailing Address - Country:US
Mailing Address - Phone:337-981-9182
Mailing Address - Fax:337-988-3441
Practice Address - Street 1:2115 DULLES DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-2652
Practice Address - Country:US
Practice Address - Phone:337-981-9182
Practice Address - Fax:337-988-3441
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist