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General NPI Number Information
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NPI Number | 1922565159
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Entity Type | Individual
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Provider Name | ROBYN M LYCAN
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Gender | Female
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Dates
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Enumeration Date | 02/24/2019
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Last Update Date | 02/24/2019
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Provider Practice Location Address
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Address Line | 421 N LAKE ST
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City | AURORA
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State | IL
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Zip | 60506-4180
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Country | US
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Telephone | 630-844-0380
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 OAK ST # 409
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City | NORTH AURORA
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State | IL
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Zip | 60542-2068
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Country | US
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Telephone | 630-701-5412
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Fax |
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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 | 070-008400
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License Number State | IL
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