Provider Demographics
NPI:1467562926
Name:MERRILL, LYRI L (PT)
Entity Type:Individual
Prefix:
First Name:LYRI
Middle Name:L
Last Name:MERRILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EXECUTIVE WOODS CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2016
Mailing Address - Country:US
Mailing Address - Phone:618-444-2846
Mailing Address - Fax:618-239-6444
Practice Address - Street 1:4 EXECUTIVE WOODS CT
Practice Address - Street 2:SUITE C
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2016
Practice Address - Country:US
Practice Address - Phone:618-444-2846
Practice Address - Fax:618-239-6444
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1121992251X0800X
IL070-0160662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1110259154034Medicare UPIN