Healthcare Provider Details

I. General information

NPI: 1558551606
Provider Name (Legal Business Name): LIDDY HEALTH WORKS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 WESTMOUNT DR
WEST HOLLYWOOD CA
90069-5108
US

IV. Provider business mailing address

606 WESTMOUNT DR
WEST HOLLYWOOD CA
90069-5108
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-3346
  • Fax: 714-547-3252
Mailing address:
  • Phone: 714-547-3346
  • Fax: 714-547-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberDC16468
License Number StateCA

VIII. Authorized Official

Name: JOHN LIDDY
Title or Position: PRESIDENT
Credential: DC
Phone: 714-547-3346