MEDICARE: TANNER SEAN LYONS DPT

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	14268847-2401	UT

General Provider Information

NPI Number	:	1649102518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANNER SEAN LYONS DPT

Provider Business Mailing Address
First Line	:	3002 N MAIN ST # 2
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1530
Country	:	US
Telephone Number	:	435-562-3158
Fax Number	:

Provider Business Practice Location Address
First Line	:	3002 N MAIN ST # 2
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1530
Country	:	US
Telephone Number	:	435-562-3158
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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