Provider Demographics
NPI:1104958461
Name:HERBERT, LYNN M (PT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:HERBERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 CASS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2919
Mailing Address - Country:US
Mailing Address - Phone:831-644-0450
Mailing Address - Fax:831-644-0466
Practice Address - Street 1:857 CASS ST
Practice Address - Street 2:SUITE A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2919
Practice Address - Country:US
Practice Address - Phone:831-644-0450
Practice Address - Fax:831-644-0466
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT163066OtherGROUP