Healthcare Provider Details

I. General information

NPI: 1922565159
Provider Name (Legal Business Name): ROBYN M LYCAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2019
Last Update Date: 02/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N LAKE ST
AURORA IL
60506-4180
US

IV. Provider business mailing address

1801 OAK ST # 409
NORTH AURORA IL
60542-2068
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-0380
  • Fax:
Mailing address:
  • Phone: 630-701-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-008400
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: