Provider Demographics
NPI:1144716473
Name:LYONS, COURTNEY
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8786 ALTHOFF RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:OH
Mailing Address - Zip Code:45380-9720
Mailing Address - Country:US
Mailing Address - Phone:937-564-3221
Mailing Address - Fax:
Practice Address - Street 1:8786 ALTHOFF RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:OH
Practice Address - Zip Code:45380-9720
Practice Address - Country:US
Practice Address - Phone:937-564-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant