Provider Demographics
NPI:1366690794
Name:LYONS, ELLEN W (LMT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:W
Last Name:LYONS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-1535
Mailing Address - Country:US
Mailing Address - Phone:419-334-7600
Mailing Address - Fax:419-334-7640
Practice Address - Street 1:728 N STONE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1535
Practice Address - Country:US
Practice Address - Phone:419-334-7600
Practice Address - Fax:419-334-7640
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15810225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist