Provider Demographics
NPI:1801311311
Name:LYONS, COLTON KENNETH JAY (LMP)
Entity type:Individual
Prefix:MR
First Name:COLTON
Middle Name:KENNETH JAY
Last Name:LYONS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 W NOB HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-5104
Mailing Address - Country:US
Mailing Address - Phone:509-248-5555
Mailing Address - Fax:509-469-4938
Practice Address - Street 1:2508 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5104
Practice Address - Country:US
Practice Address - Phone:509-248-5555
Practice Address - Fax:509-469-4938
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist