Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT17622 | FL |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT17622 | FL |
NPI | 1356335848 |
---|---|
Provider Name | Christian Lawrence Lyons |
First Address | Apo, AE 09464 |
Second Address | Apo, AE 09464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 13/07/2007 |