Provider Demographics
NPI:1215328257
Name:OPALENSKY, LYNN ANN (PTA)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:OPALENSKY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 SAINT PAUL ST
Mailing Address - Street 2:GOUND LEVEL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2618
Mailing Address - Country:US
Mailing Address - Phone:410-685-7770
Mailing Address - Fax:410-685-7851
Practice Address - Street 1:1120 SAINT PAUL ST
Practice Address - Street 2:GOUND LEVEL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2618
Practice Address - Country:US
Practice Address - Phone:410-685-7770
Practice Address - Fax:410-685-7851
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1297225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant