Provider Demographics
NPI:1235362179
Name:LYNCH, BRETT (PT)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EAST ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1638
Mailing Address - Country:US
Mailing Address - Phone:781-826-8309
Mailing Address - Fax:781-826-3610
Practice Address - Street 1:20 EAST ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1638
Practice Address - Country:US
Practice Address - Phone:781-826-8309
Practice Address - Fax:781-826-3610
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15562OtherPT LICENSE