Provider Demographics
NPI:1336168475
Name:LYALL, MARIA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:LYALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5818 HARBOUR VIEW BLVD # D
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3315
Mailing Address - Country:US
Mailing Address - Phone:757-215-1400
Mailing Address - Fax:757-215-1410
Practice Address - Street 1:5818 HARBOUR VIEW BLVD # D
Practice Address - Street 2:SUITE 150
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3315
Practice Address - Country:US
Practice Address - Phone:757-215-1400
Practice Address - Fax:757-215-1410
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA2305005449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist