Provider Demographics
NPI:1285779561
Name:TYNAN, ROBYN LEIGH (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:LEIGH
Last Name:TYNAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 BENT RIVER DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4503
Mailing Address - Country:US
Mailing Address - Phone:770-978-0394
Mailing Address - Fax:
Practice Address - Street 1:601-A PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045
Practice Address - Country:US
Practice Address - Phone:770-513-0839
Practice Address - Fax:770-513-7850
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPT008842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist