Healthcare Provider Details

I. General information

NPI: 1235222019
Provider Name (Legal Business Name): JOANNE MARY LYSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MARSHALL RD
LOWELL MA
01852-5130
US

IV. Provider business mailing address

9 WESTHILL DR
NASHUA NH
03062-1313
US

V. Phone/Fax

Practice location:
  • Phone: 978-671-9174
  • Fax:
Mailing address:
  • Phone: 603-321-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0860
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: