Provider Demographics
NPI:1376878785
Name:LYONS, JAMES KENNETH (LMT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KENNETH
Last Name:LYONS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:KENNETH
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2120 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2508
Mailing Address - Country:US
Mailing Address - Phone:502-523-2513
Mailing Address - Fax:
Practice Address - Street 1:130 FAIRFAX AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4939
Practice Address - Country:US
Practice Address - Phone:502-523-2513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-03
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY110317172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist