Provider Demographics
NPI:1386789055
Name:ARCHESKI, LYNNE DIANE (P T)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:DIANE
Last Name:ARCHESKI
Suffix:
Gender:F
Credentials:P T
Other - Prefix:MS
Other - First Name:LYNNE
Other - Middle Name:DIANE
Other - Last Name:SIECKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:P T
Mailing Address - Street 1:506 LIGHTHOUSE POINT DR
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 INDEPENDENCE DRIVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1053
Practice Address - Country:US
Practice Address - Phone:636-583-5959
Practice Address - Fax:
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
MO01026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist