Provider Demographics
NPI:1063523785
Name:LYNCH, AMY SMALL (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SMALL
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-954-7408
Practice Address - Street 1:601 S MAIN ST
Practice Address - Street 2:UNIT B
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5035
Practice Address - Country:US
Practice Address - Phone:336-342-3383
Practice Address - Fax:336-342-3384
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130VGOtherBCBS
NC7211069Medicaid
NC7211069Medicaid