Provider Demographics
NPI:1336297530
Name:LYNCH, KELLY NICOLE (MPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S UNIVERSITY RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5227
Mailing Address - Country:US
Mailing Address - Phone:509-921-9798
Mailing Address - Fax:509-921-9774
Practice Address - Street 1:325 S UNIVERSITY RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5227
Practice Address - Country:US
Practice Address - Phone:509-921-9798
Practice Address - Fax:509-921-9774
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT9034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA912046547OtherTAX ID