Provider Demographics
NPI:1679779920
Name:KYMES-LYONS PHYSICAL THERAPY AND SPORTS PERFORMANCE CENTER PA
Entity Type:Organization
Organization Name:KYMES-LYONS PHYSICAL THERAPY AND SPORTS PERFORMANCE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:479-495-6326
Mailing Address - Street 1:994 CENTER VALLEY RD
Mailing Address - Street 2:PO BOX 217
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811
Mailing Address - Country:US
Mailing Address - Phone:479-495-6326
Mailing Address - Fax:479-495-3336
Practice Address - Street 1:575 CLUB LANE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032
Practice Address - Country:US
Practice Address - Phone:479-495-6326
Practice Address - Fax:479-495-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT437261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR=========OtherTAX ID NUMBER