Provider Demographics
NPI:1225161797
Name:LYNN, MARY R (LPTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:LYNN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13209 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2646
Mailing Address - Country:US
Mailing Address - Phone:804-883-5061
Mailing Address - Fax:
Practice Address - Street 1:13700 N GAYTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7017
Practice Address - Country:US
Practice Address - Phone:804-364-6352
Practice Address - Fax:804-364-6070
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000485225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant