Provider Demographics
NPI:1215163266
Name:DAVIS, LYNN C (PT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:C
Other - Last Name:GRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12 E CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2502
Mailing Address - Country:US
Mailing Address - Phone:609-707-5655
Mailing Address - Fax:856-910-0046
Practice Address - Street 1:3104 BRIDGEBORO RD STE B
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-9716
Practice Address - Country:US
Practice Address - Phone:568-910-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00541900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist