Provider Demographics
NPI:1013489236
Name:LYVERS, RILEY C (MS, ATC, NASM-CES)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:C
Last Name:LYVERS
Suffix:
Gender:M
Credentials:MS, ATC, NASM-CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13776 MCCABE DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-6849
Mailing Address - Country:US
Mailing Address - Phone:708-267-4465
Mailing Address - Fax:
Practice Address - Street 1:1408 3RD AVE. APT 15
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-6849
Practice Address - Country:US
Practice Address - Phone:708-267-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
390200000X
WVAT0017782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program