Provider Demographics
NPI:1518025451
Name:LYONS, MELISSA MARIE (MS,PT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MARIE
Last Name:LYONS
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:LEITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,PT
Mailing Address - Street 1:1061 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1802
Mailing Address - Country:US
Mailing Address - Phone:516-454-6387
Mailing Address - Fax:516-454-6303
Practice Address - Street 1:1061 N BROADWAY
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1802
Practice Address - Country:US
Practice Address - Phone:516-454-6387
Practice Address - Fax:516-454-6303
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist