Provider Demographics
NPI:1518135334
Name:REORDAN, LYNN ELLEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ELLEN
Last Name:REORDAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:ELLEN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:635 N. 5TH ST.
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530
Mailing Address - Country:US
Mailing Address - Phone:541-899-8179
Mailing Address - Fax:541-899-0244
Practice Address - Street 1:635 N. 5TH ST.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530
Practice Address - Country:US
Practice Address - Phone:541-899-8179
Practice Address - Fax:541-899-0244
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4337225100000X
OR03337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist