MEDICARE: DAVID P LYONS P.T.

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
1	225100000X	Physical Therapist	267	AK

General Provider Information

NPI Number	:	1174842413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID P LYONS P.T.

Provider Business Mailing Address
First Line	:	PO BOX 241769
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99524-1769
Country	:	US
Telephone Number	:	907-770-2380
Fax Number	:	907-770-2341

Provider Business Practice Location Address
First Line	:	1045 E KLATT RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3541
Country	:	US
Telephone Number	:	907-770-2380
Fax Number	:	907-770-2341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	05/26/2010

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