Provider Demographics
NPI:1124340161
Name:LANDRETH, LYNN Y (PT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:Y
Last Name:LANDRETH
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 1:800 GOODLETTE RD N
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5400
Mailing Address - Country:US
Mailing Address - Phone:239-643-8766
Mailing Address - Fax:239-435-0119
Practice Address - Street 1:800 GOODLETTE RD N
Practice Address - Street 2:SUITE 140
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5400
Practice Address - Country:US
Practice Address - Phone:239-643-8766
Practice Address - Fax:239-435-0119
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist