Provider Demographics
NPI:1346622677
Name:LYNCH, KATHY (DPT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1573
Mailing Address - Country:US
Mailing Address - Phone:541-231-3644
Mailing Address - Fax:541-844-0127
Practice Address - Street 1:2323 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1573
Practice Address - Country:US
Practice Address - Phone:541-231-3644
Practice Address - Fax:541-844-0127
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT61092225100000X
OR61092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist