MEDICARE: LYRA MARIE DONAHUE PT

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	PTH1783	AL

General Provider Information

NPI Number	:	1518024538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYRA MARIE DONAHUE PT

Provider Business Mailing Address
First Line	:	535 COUNTY ROAD 696
Second Line	:
City	:	CEDAR BLUFF
State	:	AL
Zip	:	35959-3449
Country	:	US
Telephone Number	:	256-779-8020
Fax Number	:	256-845-8964

Provider Business Practice Location Address
First Line	:	701 GAULT AVE N STE A
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-2627
Country	:	US
Telephone Number	:	256-845-8994
Fax Number	:

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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