Provider Demographics
NPI:1427272822
Name:IMHOFF, LYNN HELEN (PT)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:HELEN
Last Name:IMHOFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TANDEM VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2382
Mailing Address - Country:US
Mailing Address - Phone:724-843-3400
Mailing Address - Fax:724-843-3400
Practice Address - Street 1:100 TANDEM VILLAGE RD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-2382
Practice Address - Country:US
Practice Address - Phone:724-843-3400
Practice Address - Fax:724-843-3400
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008626L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010130510001Medicaid