Provider Demographics
NPI:1518486588
Name:THAYER, LYNDA RUSSELL (LMT)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:RUSSELL
Last Name:THAYER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:RUSSELL
Other - Last Name:THAYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:281 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4778
Mailing Address - Country:US
Mailing Address - Phone:508-875-1705
Mailing Address - Fax:
Practice Address - Street 1:281 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4778
Practice Address - Country:US
Practice Address - Phone:508-875-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA$$$$$$$$$OtherBLUE CROSS BLUE SHIELD