Provider Demographics
NPI:1447568019
Name:RICHARDSON, LYNN AMY (DO)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:AMY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 E SOCIAL ROW RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4728
Mailing Address - Country:US
Mailing Address - Phone:937-885-0627
Mailing Address - Fax:
Practice Address - Street 1:1785 E SOCIAL ROW RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-4728
Practice Address - Country:US
Practice Address - Phone:937-885-0627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007002208100000X
OH34-0070022081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093366Medicaid
OHP01466523Medicare PIN
OHH215030Medicare PIN