Provider Demographics
NPI:1407063829
Name:STROMQUIST, LYNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:STROMQUIST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-2422
Mailing Address - Country:US
Mailing Address - Phone:585-750-4456
Mailing Address - Fax:
Practice Address - Street 1:425 TITUS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3532
Practice Address - Country:US
Practice Address - Phone:585-750-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015920225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY165408GGOtherPREFERRED CARE PROVIDER #