Provider Demographics
NPI:1538514088
Name:LYONS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LYONS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-484-2134
Mailing Address - Street 1:PO BOX 6581
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-0581
Mailing Address - Country:US
Mailing Address - Phone:208-484-2134
Mailing Address - Fax:
Practice Address - Street 1:770 S 13TH ST
Practice Address - Street 2:UNIT 6581
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83707-0002
Practice Address - Country:US
Practice Address - Phone:208-484-2134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1156261QP2000X, 261QR0401X, 282N00000X, 302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No282N00000XHospitalsGeneral Acute Care Hospital
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service