Provider Demographics
NPI:1780676767
Name:LYON, RICHARD B (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:LYON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 CLEARVIEW RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-3180
Mailing Address - Country:US
Mailing Address - Phone:412-492-8691
Mailing Address - Fax:
Practice Address - Street 1:2661 CLEARVIEW RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-3180
Practice Address - Country:US
Practice Address - Phone:412-492-8691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005873L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232925157OtherCOMMERCIAL INSURANCE
PA516839OtherBLUE CROSS BLUE SHIELD
PA516839Medicare ID - Type Unspecified