Provider Demographics
NPI:1659318749
Name:LYONS, JOHN P (MPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:LYONS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8705 RED BROOK DR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8444
Mailing Address - Country:US
Mailing Address - Phone:702-644-3398
Mailing Address - Fax:702-832-5930
Practice Address - Street 1:600 S RANCHO DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4867
Practice Address - Country:US
Practice Address - Phone:702-794-0300
Practice Address - Fax:702-832-5930
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504120Medicaid
NV11487010OtherCAQH
NV1659318749Medicaid
NVV40110Medicare PIN
NV100504120Medicaid