Provider Demographics
NPI:1346522570
Name:MCDONOUGH, LYNNE MARIE
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 BIRKDALE CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4684
Mailing Address - Country:US
Mailing Address - Phone:910-868-3824
Mailing Address - Fax:
Practice Address - Street 1:1601 PURDUE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3674
Practice Address - Country:US
Practice Address - Phone:910-672-0061
Practice Address - Fax:910-672-0061
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist