Healthcare Provider Details

I. General information

NPI: 1588632277
Provider Name (Legal Business Name): MARILYN F LYONS MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E PRATER WAY SUITE 103
SPARKS NV
89434
US

IV. Provider business mailing address

PO BOX 9624
TRUCKEE CA
96162
US

V. Phone/Fax

Practice location:
  • Phone: 775-331-1199
  • Fax: 775-331-1180
Mailing address:
  • Phone: 530-587-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1191
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: