Provider Demographics
NPI:1023496924
Name:LYONS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:LYONS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-476-0222
Mailing Address - Street 1:600 S TONOPAH DR STE 230
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4042
Mailing Address - Country:US
Mailing Address - Phone:702-476-0222
Mailing Address - Fax:702-832-5730
Practice Address - Street 1:600 S TONOPAH DR STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4042
Practice Address - Country:US
Practice Address - Phone:702-664-3398
Practice Address - Fax:702-832-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20151244262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504120Medicaid
NVV40110Medicare PIN
NV100504120Medicaid