Provider Demographics
NPI:1962411397
Name:LYONS, BRADLEY JAMES (MSPT COMT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAMES
Last Name:LYONS
Suffix:
Gender:M
Credentials:MSPT COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23006 E COLT LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9512
Mailing Address - Country:US
Mailing Address - Phone:509-922-7752
Mailing Address - Fax:509-928-7662
Practice Address - Street 1:15407 E MISSION AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8527
Practice Address - Country:US
Practice Address - Phone:509-928-3111
Practice Address - Fax:509-928-7662
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist