Healthcare Provider Details

I. General information

NPI: 1134852007
Provider Name (Legal Business Name): SAVANNAH JEANE LYONS SPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35249 KENAI SPUR HWY STE C
SOLDOTNA AK
99669-7673
US

IV. Provider business mailing address

47401 DAMON AVE UNIT D
SOLDOTNA AK
99669-9281
US

V. Phone/Fax

Practice location:
  • Phone: 907-420-0836
  • Fax: 907-420-0837
Mailing address:
  • Phone: 816-721-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number192665
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: