Provider Demographics
NPI:1164964409
Name:LYNCH, DARRAGH JOSEPH
Entity Type:Individual
Prefix:
First Name:DARRAGH
Middle Name:JOSEPH
Last Name:LYNCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 CADILLAC AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1702
Mailing Address - Country:US
Mailing Address - Phone:323-857-4269
Mailing Address - Fax:
Practice Address - Street 1:350 N ERVAY ST
Practice Address - Street 2:APT 3107
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3830
Practice Address - Country:US
Practice Address - Phone:817-657-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1216429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist