Provider Demographics
NPI:1962761627
Name:SILVERTHORN, LYLE ANDREW (PT)
Entity type:Individual
Prefix:
First Name:LYLE
Middle Name:ANDREW
Last Name:SILVERTHORN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 ANDERSON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0772
Mailing Address - Country:US
Mailing Address - Phone:530-758-2222
Mailing Address - Fax:530-758-2283
Practice Address - Street 1:2019 ANDERSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0772
Practice Address - Country:US
Practice Address - Phone:530-758-2222
Practice Address - Fax:530-758-2283
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist