Provider Demographics
NPI:1417922162
Name:LYNCH, MATTHEW D (MPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2749
Mailing Address - Country:US
Mailing Address - Phone:315-422-2912
Mailing Address - Fax:
Practice Address - Street 1:1054 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2749
Practice Address - Country:US
Practice Address - Phone:315-422-2912
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0263251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0263251OtherLICENSE
NYRA4229Medicare ID - Type UnspecifiedPROVIDER NUMBER