Provider Demographics
NPI:1043538697
Name:DAVIS, LYNDA DIANE (PTA)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:DIANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16002 LAKESHORE VILLA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1367
Mailing Address - Country:US
Mailing Address - Phone:813-968-5093
Mailing Address - Fax:813-968-5934
Practice Address - Street 1:16002 LAKESHORE VILLA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1367
Practice Address - Country:US
Practice Address - Phone:813-968-5093
Practice Address - Fax:813-968-5934
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA619225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant