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NPI Code Detail

MEDICARE: ALICIA MARIE LYON

MEDICARE: ALICIA MARIE LYON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1023670460
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA MARIE LYON
Provider Business Mailing Address
First Line : 2024 LAKELAND DR
Second Line :
City : FAIRVIEW
State : PA
Zip : 16415
Country : US
Telephone Number : 814-823-9181
Fax Number :
Provider Business Practice Location Address
First Line : 2024 LAKELAND DR
Second Line :
City : FAIRVIEW
State : PA
Zip : 16415-1911
Country : US
Telephone Number : 814-823-9181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2019
Last Update Date : 07/06/2019

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Directions to “ ALICIA MARIE LYON ” Practice Location

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