Provider Demographics
NPI:1609630656
Name:LYV, WILLIAM (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:LYV
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15375 BARRANCA PKWY STE A103
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2203
Mailing Address - Country:US
Mailing Address - Phone:949-590-9350
Mailing Address - Fax:949-346-5350
Practice Address - Street 1:15375 BARRANCA PKWY STE A103
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2203
Practice Address - Country:US
Practice Address - Phone:949-590-9350
Practice Address - Fax:949-346-5350
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist