Provider Demographics
NPI:1487072310
Name:LYNCH, COLIN (LMT)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16211 ECKHART RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-7366
Mailing Address - Country:US
Mailing Address - Phone:443-486-8599
Mailing Address - Fax:
Practice Address - Street 1:401 N WASHINGTON ST
Practice Address - Street 2:SUITE 168
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1737
Practice Address - Country:US
Practice Address - Phone:301-279-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist