Provider Demographics
NPI:1497151393
Name:LYNCH, MELODY J (PTA)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:J
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S DURHAM ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-1805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9891 BROKEN LAND PKWY
Practice Address - Street 2:SUITE 306
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1165
Practice Address - Country:US
Practice Address - Phone:301-362-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4128225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant