Provider Demographics
NPI:1164483541
Name:FLYNN, PAUL EDWIN (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EDWIN
Last Name:FLYNN
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2775
Mailing Address - Country:US
Mailing Address - Phone:563-332-4516
Mailing Address - Fax:563-332-8761
Practice Address - Street 1:3333 18TH ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2775
Practice Address - Country:US
Practice Address - Phone:563-332-4516
Practice Address - Fax:563-332-8761
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer