Provider Demographics
NPI:1972635563
Name:LYONS, CATHERINE (DPT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:L
Other - Last Name:PRENDERGAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:730 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2818
Mailing Address - Country:US
Mailing Address - Phone:219-924-3300
Mailing Address - Fax:219-836-0570
Practice Address - Street 1:730 45TH ST
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2818
Practice Address - Country:US
Practice Address - Phone:219-924-3300
Practice Address - Fax:219-836-0570
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002866A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000485099OtherANTHEM
IN386960IMedicare ID - Type UnspecifiedMEDICARE
P00311361Medicare ID - Type UnspecifiedRAILROAD MEDICARE