Provider Demographics
NPI:1518024538
Name:DONAHUE, LYRA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:LYRA
Middle Name:MARIE
Last Name:DONAHUE
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 1:535 COUNTY ROAD 696
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:AL
Mailing Address - Zip Code:35959-3449
Mailing Address - Country:US
Mailing Address - Phone:256-779-8020
Mailing Address - Fax:256-845-8964
Practice Address - Street 1:701 GAULT AVE N STE A
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-2627
Practice Address - Country:US
Practice Address - Phone:256-845-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist