Provider Demographics
NPI:1093746216
Name:WINTER, LYNN ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ANN
Last Name:WINTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LYNN
Other - Middle Name:ANN
Other - Last Name:FLANNERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:501 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1541
Mailing Address - Country:US
Mailing Address - Phone:570-457-4099
Mailing Address - Fax:570-457-7205
Practice Address - Street 1:501 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1541
Practice Address - Country:US
Practice Address - Phone:570-457-4099
Practice Address - Fax:570-457-7205
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT08108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA105447Q69Medicare ID - Type Unspecified