Provider Demographics
NPI:1689886780
Name:LYKEN, HERBERT E (MSPT)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:E
Last Name:LYKEN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EMELINE ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1917
Mailing Address - Country:US
Mailing Address - Phone:781-223-5287
Mailing Address - Fax:
Practice Address - Street 1:525 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4219
Practice Address - Country:US
Practice Address - Phone:781-344-4449
Practice Address - Fax:781-344-1170
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist