MEDICARE: ALEXIS LYONS PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	047390	NY
2	225100000X	Physical Therapist	24776	PA

General Provider Information

NPI Number	:	1083243257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS LYONS PT, DPT

Provider Business Mailing Address
First Line	:	31 E 32ND ST FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-5595
Country	:	US
Telephone Number	:	646-518-5562
Fax Number	:	212-298-9893

Provider Business Practice Location Address
First Line	:	630 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6705
Country	:	US
Telephone Number	:	646-829-2290
Fax Number	:	212-298-9896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	09/14/2021

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