Provider Demographics
NPI:1740553700
Name:LY, AN LAP
Entity type:Individual
Prefix:
First Name:AN
Middle Name:LAP
Last Name:LY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANDY
Other - Middle Name:LAP
Other - Last Name:LY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:33162 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5915
Mailing Address - Country:US
Mailing Address - Phone:586-977-0202
Mailing Address - Fax:586-977-6688
Practice Address - Street 1:33162 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5915
Practice Address - Country:US
Practice Address - Phone:586-977-0202
Practice Address - Fax:586-977-6688
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID5476V173C00000X, 174400000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173C00000XOther Service ProvidersReflexologist
No175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI593764-10OtherNATIONAL CERTIFICATION BOARD FOR THERAPUETIC MASSAGE & BODYWORK (NCBTMB)
MI966552OtherASSOCIATED BODYWORK & MASSAGE PROFESSIONAL (ABMP)