Provider Demographics
NPI:1982241931
Name:LYON, MARISSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 CONGRESS ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2111
Mailing Address - Country:US
Mailing Address - Phone:207-888-0900
Mailing Address - Fax:
Practice Address - Street 1:1274 CONGRESS ST FL 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2111
Practice Address - Country:US
Practice Address - Phone:207-888-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT55052251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology