Healthcare Provider Details

I. General information

NPI: 1417195223
Provider Name (Legal Business Name): EILEEN PATRICIA LYONS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 VINELAND RD 304
ORLANDO FL
32819-7800
US

IV. Provider business mailing address

5979 VINELAND RD 304
ORLANDO FL
32819-7800
US

V. Phone/Fax

Practice location:
  • Phone: 407-354-3906
  • Fax: 407-354-3907
Mailing address:
  • Phone: 407-354-3906
  • Fax: 407-354-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: