Provider Demographics
NPI:1326682485
Name:LYONS, MERRILY ANN (ATC, LMBT)
Entity Type:Individual
Prefix:
First Name:MERRILY
Middle Name:ANN
Last Name:LYONS
Suffix:
Gender:F
Credentials:ATC, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 41ST ST NW APT 103
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4997
Mailing Address - Country:US
Mailing Address - Phone:704-999-5797
Mailing Address - Fax:
Practice Address - Street 1:4501 UNIVERSITY DR
Practice Address - Street 2:GMU SPORTS MEDICINE
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-993-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18087225700000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist