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General NPI Number Information
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NPI Number | 1588200323
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Entity Type | Individual
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Provider Name | JOHN LY PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 3043 59TH AVE SW APT B
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City | SEATTLE
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State | WA
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Zip | 98116-4722
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Country | US
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Telephone | 201-982-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 3043 59TH AVE SW APT B
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City | SEATTLE
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State | WA
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Zip | 98116-4722
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Country | US
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Telephone | 201-982-3344
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01935900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 045270
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT61290039
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License Number State | WA
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