Provider Demographics
NPI:1417192105
Name:MAFFEO, LYNNE D (PT)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:D
Last Name:MAFFEO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555D ROUND ROCK WEST DR
Mailing Address - Street 2:160
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681
Mailing Address - Country:US
Mailing Address - Phone:512-244-6623
Mailing Address - Fax:512-244-7758
Practice Address - Street 1:555D ROUND ROCK WEST DR
Practice Address - Street 2:160
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681
Practice Address - Country:US
Practice Address - Phone:512-244-6623
Practice Address - Fax:512-244-7758
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist