Provider Demographics
NPI:1982905279
Name:LYON, TRACY ENGEL (DPT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ENGEL
Last Name:LYON
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 1:1939 WILMINGTON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-6404
Mailing Address - Country:US
Mailing Address - Phone:970-377-1422
Mailing Address - Fax:970-377-1839
Practice Address - Street 1:1939 WILMINGTON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6404
Practice Address - Country:US
Practice Address - Phone:970-377-1422
Practice Address - Fax:970-377-1839
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist