Provider Demographics
NPI:1013358324
Name:LYO, PATRICK (DPT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:LYO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 VAN LOON ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4258
Mailing Address - Country:US
Mailing Address - Phone:347-220-8195
Mailing Address - Fax:866-202-3177
Practice Address - Street 1:5205 VAN LOON ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4258
Practice Address - Country:US
Practice Address - Phone:347-220-8195
Practice Address - Fax:866-202-3177
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist