Provider Demographics
NPI:1588632277
Name:LYONS, MARILYN F (MPT)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:F
Last Name:LYONS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9624
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96162
Mailing Address - Country:US
Mailing Address - Phone:530-587-3786
Mailing Address - Fax:
Practice Address - Street 1:1450 E PRATER WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434
Practice Address - Country:US
Practice Address - Phone:775-331-1199
Practice Address - Fax:775-331-1180
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist