Provider Demographics
NPI:1841031739
Name:LYVERS, LUKE
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:LYVERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 SILVER FOX DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3218
Mailing Address - Country:US
Mailing Address - Phone:812-341-1999
Mailing Address - Fax:
Practice Address - Street 1:1940 E TIPTON ST STE C
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3566
Practice Address - Country:US
Practice Address - Phone:812-271-0042
Practice Address - Fax:812-248-8002
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06006702A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant