Provider Demographics
NPI:1740563998
Name:LYON, SCOTT WILLIAM (DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:WILLIAM
Last Name:LYON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 FRONT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1729
Mailing Address - Country:US
Mailing Address - Phone:360-354-0585
Mailing Address - Fax:360-354-1098
Practice Address - Street 1:1824 FRONT ST
Practice Address - Street 2:SUITE A
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1729
Practice Address - Country:US
Practice Address - Phone:360-354-0585
Practice Address - Fax:360-354-1098
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60236099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist