Andersen, Lyle Melvin

Andersen, Lyle Melvin is an individual health care provider with primary practice located at 1917 Coffee Rd , Modesto CA 95355-2704. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Andersen, Lyle Melvin can be contacted via phone (209) 549-4626.

Contact Information

Primary practice address
1917 Coffee Rd Modesto CA 95355-2704
Phone: (209) 549-4626
Fax: (209) 549-4625
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT5278 California

Profile Details

NPI number 1265413918
LBN Legal business name Andersen, Lyle Melvin
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 9th, 2005
Last updated Apr 17th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265413918 NPPES
California MEDICAID 00PT52780

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