Healthcare Provider Details

I. General information

NPI: 1679779920
Provider Name (Legal Business Name): KYMES-LYONS PHYSICAL THERAPY AND SPORTS PERFORMANCE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 CLUB LANE
CONWAY AR
72032
US

IV. Provider business mailing address

994 CENTER VALLEY RD PO BOX 217
RUSSELLVILLE AR
72811
US

V. Phone/Fax

Practice location:
  • Phone: 479-495-6326
  • Fax: 479-495-3336
Mailing address:
  • Phone: 479-495-6326
  • Fax: 479-495-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberPT437
License Number StateAR

VIII. Authorized Official

Name: MR. DANNY R LYONS
Title or Position: OWNER
Credential: RPT
Phone: 479-495-6326