Provider Demographics
NPI:1508292079
Name:ELBERSON LYON, ERIN ELIZABETH (PT)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:ELIZABETH
Last Name:ELBERSON LYON
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 1:717 SW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2422
Mailing Address - Country:US
Mailing Address - Phone:954-612-3501
Mailing Address - Fax:
Practice Address - Street 1:110 SE 6TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-5000
Practice Address - Country:US
Practice Address - Phone:954-617-6467
Practice Address - Fax:954-344-9708
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist