Provider Demographics
NPI:1215975404
Name:LYNN, THOMAS J (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:LYNN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3001
Mailing Address - Country:US
Mailing Address - Phone:845-634-8441
Mailing Address - Fax:845-634-1873
Practice Address - Street 1:369 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3001
Practice Address - Country:US
Practice Address - Phone:845-634-8441
Practice Address - Fax:845-634-1873
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ60071Medicare PIN