Provider Demographics
NPI:1295936599
Name:LYON, AGYNESS G (LMT CHT)
Entity type:Individual
Prefix:
First Name:AGYNESS
Middle Name:G
Last Name:LYON
Suffix:
Gender:F
Credentials:LMT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 S CUSHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3439
Mailing Address - Country:US
Mailing Address - Phone:206-866-8732
Mailing Address - Fax:
Practice Address - Street 1:922 MCGILVRA BLVD E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5000
Practice Address - Country:US
Practice Address - Phone:206-324-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00006036225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist