Provider Demographics
NPI:1962423673
Name:HOUSE, LYNNE GATES (PT)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:GATES
Last Name:HOUSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2120 SEMINOLE SHORES LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-3125
Mailing Address - Country:US
Mailing Address - Phone:772-231-1258
Mailing Address - Fax:
Practice Address - Street 1:1705 17TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3641
Practice Address - Country:US
Practice Address - Phone:772-562-6877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT43312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic