Healthcare Provider Details

I. General information

NPI: 1376791459
Provider Name (Legal Business Name): LORI A LYONS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MASONIC AVE
WALLINGFORD CT
06492-3048
US

IV. Provider business mailing address

22 MASONIC AVE
WALLINGFORD CT
06492-3048
US

V. Phone/Fax

Practice location:
  • Phone: 203-679-6273
  • Fax: 203-679-6142
Mailing address:
  • Phone: 203-679-6273
  • Fax: 203-679-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005571
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: