Provider Demographics
NPI:1245897826
Name:MEDEIROS, EMILY LYNCH
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:LYNCH
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:LYNCH
Other - Last Name:MEDEIROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:73-5590 KAUHOLA ST STE A
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2610
Mailing Address - Country:US
Mailing Address - Phone:808-329-7744
Mailing Address - Fax:808-334-1608
Practice Address - Street 1:73-5590 KAUHOLA ST STE A
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2610
Practice Address - Country:US
Practice Address - Phone:808-329-7744
Practice Address - Fax:808-334-1608
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24387225100000X
225100000X, 390200000X
HIPT-5401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program