Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1235233529 |
---|---|
Provider Name | Mr. Mike Lyons |
First Address | Bay Pines, FL 33744-0337 |
Second Address | Bay Pines, FL 33744-0337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 08/07/2007 |