Provider Demographics
NPI:1164820262
Name:GIRTON, LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GIRTON
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 1:2979 KENTVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-4266
Mailing Address - Country:US
Mailing Address - Phone:608-213-8141
Mailing Address - Fax:
Practice Address - Street 1:2979 KENTVILLE DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-4266
Practice Address - Country:US
Practice Address - Phone:608-213-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2258225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2258OtherSTATE OF WISCONSIN PHYSICAL THERAPY EXAMINING BOARD