Provider Demographics
NPI:1497033054
Name:LYNCH, GRACE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GLENNA
Other - Middle Name:MARIE EILEEN
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:STE. 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:7195 WAGNER WAY
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6906
Practice Address - Country:US
Practice Address - Phone:253-313-5102
Practice Address - Fax:253-527-5353
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8923869Medicare PIN
WAG8923868Medicare PIN