Provider Demographics
NPI:1265145205
Name:LIM, RYAN ALVAR (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ALVAR
Last Name:LIM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11957 ARMINTA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2504
Mailing Address - Country:US
Mailing Address - Phone:818-915-2183
Mailing Address - Fax:
Practice Address - Street 1:650 W DUARTE RD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7617
Practice Address - Country:US
Practice Address - Phone:818-915-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist