MEDICARE: RICHARD B LYON 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	174400000X	Specialist	PT005873L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	232925157	OTHER	PA	COMMERCIAL INSURANCE
2	516839	OTHER	PA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1780676767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD B LYON PT

Provider Business Mailing Address
First Line	:	2661 CLEARVIEW RD
Second Line	:	SUITE 4
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-3180
Country	:	US
Telephone Number	:	412-492-8691
Fax Number	:

Provider Business Practice Location Address
First Line	:	2661 CLEARVIEW RD
Second Line	:	SUITE 4
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-3180
Country	:	US
Telephone Number	:	412-492-8691
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	08/17/2010

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