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General NPI Number Information
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NPI Number | 1962411397
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Entity Type | Individual
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Provider Name | BRADLEY JAMES LYONS MSPT COMT
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15407 E MISSION AVE STE 300
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037-8527
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Country | US
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Telephone | 509-928-3111
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Fax | 509-928-7662
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Provider Business Mailing Address
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Address Line | 23006 E COLT LN
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-9512
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Country | US
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Telephone | 509-922-7752
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Fax | 509-928-7662
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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 | 9054
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License Number State | WA
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