Provider Demographics
NPI:1013016526
Name:PARRISH, LYNN M (PT)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:M
Last Name:PARRISH
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 1:2873 ARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5099
Mailing Address - Country:US
Mailing Address - Phone:541-858-4106
Mailing Address - Fax:
Practice Address - Street 1:1060 CRATER LAKE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-2203
Practice Address - Country:US
Practice Address - Phone:541-776-2035
Practice Address - Fax:541-776-2036
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500608128Medicaid
OR500608128Medicaid
ORR147663Medicare PIN