Doctor Name: | LYRA RIVERA PHAN |
NPI Number: | 1023142601 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | 100097 |
Business Practice Address: | 250 New Florissant Rd S Florissant, MO - 63013 |
Business Phone Number: | 3148307950 |
Business Fax Number: | |
Mailing Address: | 12858 Strathearn Dr, ST LOUIS |
State: | MO |
Postal Code: | 63146 |
Phone Number: | 3143071714 |
Fax Number: | |
NPI Enumeration Date: | 03/15/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 100097 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |