Provider Demographics
NPI:1043400500
Name:DREYFUS, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:DREYFUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 BEACON ST STE 19
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3793
Mailing Address - Country:US
Mailing Address - Phone:176-852-3557
Mailing Address - Fax:
Practice Address - Street 1:1318 BEACON ST STE 19
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3793
Practice Address - Country:US
Practice Address - Phone:617-852-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist