Provider Demographics
NPI:1124700901
Name:GEORGE, LYNN EDWARD JR
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:EDWARD
Last Name:GEORGE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 ADKINS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2806
Mailing Address - Country:US
Mailing Address - Phone:361-779-0720
Mailing Address - Fax:
Practice Address - Street 1:2101 FAIRLAND RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5427
Practice Address - Country:US
Practice Address - Phone:301-384-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2162277225200000X
MDCP024266A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant