Provider Demographics
NPI:1083791891
Name:TAYLOR, LYN PAUL (RPT)
Entity Type:Individual
Prefix:MR
First Name:LYN
Middle Name:PAUL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1505
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1608
Mailing Address - Country:US
Mailing Address - Phone:213-384-2330
Mailing Address - Fax:213-384-2320
Practice Address - Street 1:3250 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1505
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1608
Practice Address - Country:US
Practice Address - Phone:213-384-2330
Practice Address - Fax:213-384-2320
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT5908OtherPT STATE LICENSE
CAWPT5908AMedicare ID - Type UnspecifiedMEDICARE PPIN