Provider Demographics
NPI:1780837005
Name:LIDDY HEALTH WORKS
Entity Type:Organization
Organization Name:LIDDY HEALTH WORKS
Other - Org Name:LIDDY HEALTH WORKS INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SERVICE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:BILLING SPECIALIST
Authorized Official - Phone:858-504-0595
Mailing Address - Street 1:8535 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4100
Mailing Address - Country:US
Mailing Address - Phone:310-659-1959
Mailing Address - Fax:310-659-4769
Practice Address - Street 1:8535 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4100
Practice Address - Country:US
Practice Address - Phone:310-659-1959
Practice Address - Fax:310-659-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16468111N00000X, 111NR0400X
CAPT28268208100000X, 2081N0008X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty