MEDICARE: MS. CYNTHIA LYONS P.T., LMT

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	PT 6114	FL
2	225700000X	Massage Therapist	MA38366	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20-2460084	OTHER	FL	TAX ID #

General Provider Information

NPI Number	:	1982705455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA LYONS P.T., LMT

Provider Business Mailing Address
First Line	:	6413 JACK WRIGHT ISLAND RD
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-1910
Country	:	US
Telephone Number	:	904-607-9991
Fax Number	:

Provider Business Practice Location Address
First Line	:	6413 JACK WRIGHT ISLAND RD
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-1910
Country	:	US
Telephone Number	:	904-607-9991
Fax Number	:

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	02/20/2017

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