Individual
DERRICK GEDDES LYONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
1642 E ADELAIDE DR, MERIDIAN, ID 83642-9225
(904) 540-8975
Mailing address
1642 E ADELAIDE DR, MERIDIAN, ID 83642-9225
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT - 2994
ID
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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