Provider Demographics
NPI:1235437765
Name:LYNCH, KENDALL LEE (DPT, OCS)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:LEE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WILLIAM ST RM 800
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5347
Mailing Address - Country:US
Mailing Address - Phone:212-267-0240
Mailing Address - Fax:866-928-4144
Practice Address - Street 1:156 WILLIAM ST RM 800
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5347
Practice Address - Country:US
Practice Address - Phone:212-267-0240
Practice Address - Fax:866-928-4144
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC871791225100000X
FLPT26371225100000X
NY044009225100000X
MD26189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0J4HOtherBLUE CROSS BLUE SHIELD
FL009189300Medicaid
FLHO707ZMedicare PIN