Provider Demographics
NPI:1366030975
Name:LYONS HOWARD, DESIREE LYNN (DPT)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:LYNN
Last Name:LYONS HOWARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:DESIREE
Other - Middle Name:LYNN
Other - Last Name:LYONS HOWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:3191 MISSION INN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4188
Mailing Address - Country:US
Mailing Address - Phone:951-684-2874
Mailing Address - Fax:951-684-2980
Practice Address - Street 1:3191 MISSION INN AVE STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-4188
Practice Address - Country:US
Practice Address - Phone:951-684-2874
Practice Address - Fax:951-684-2980
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT299713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty