Provider Demographics
NPI:1528291564
Name:LYNCH, THOMAS LARRY
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LARRY
Last Name:LYNCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-1292
Mailing Address - Country:US
Mailing Address - Phone:307-864-2153
Mailing Address - Fax:307-864-2408
Practice Address - Street 1:2741 OWL CREEK RD
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-9143
Practice Address - Country:US
Practice Address - Phone:307-864-2153
Practice Address - Fax:307-864-2408
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator