Individual
PETER VAN LY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
313 W FAIRVIEW AVE, SAN GABRIEL, CA 91776-2944
(314) 398-9331
Mailing address
313 W FAIRVIEW AVE, SAN GABRIEL, CA 91776-2944
(314) 398-9331
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
50885
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50885
22
CA
Enumeration date
11/25/2020
Last updated
11/25/2020
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