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General NPI Number Information
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NPI Number | 1619295714
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Entity Type | Individual
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Provider Name | JONATHAN AVERY LYON DPT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 3200 W. MCGRAW STREET
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City | SEATTLE
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State | WA
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Zip | 98199
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Country | US
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Telephone | 206-281-7970
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Fax | 425-746-2471
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Provider Business Mailing Address
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Address Line | 1560 140TH AVENUE NE SUITE 100
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City | BELLEVUE
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State | WA
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Zip | 98005
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Country | US
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Telephone | 425-746-2475
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Fax | 425-746-2471
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60146373
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License Number State | WA
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