Provider Demographics
NPI:1558599134
Name:LYONS, AMY LYNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:LYONS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16681 MCGREGOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3830
Mailing Address - Country:US
Mailing Address - Phone:239-454-7509
Mailing Address - Fax:239-466-3311
Practice Address - Street 1:16681 MCGREGOR BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3830
Practice Address - Country:US
Practice Address - Phone:239-454-7509
Practice Address - Fax:239-466-3311
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 37008225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist