Provider Demographics
NPI:1528366168
Name:LYNN, JANET (SP6251)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:SP6251
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91073
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-1073
Mailing Address - Country:US
Mailing Address - Phone:562-490-0210
Mailing Address - Fax:562-427-0270
Practice Address - Street 1:5199 E PACIFIC COAST HWY
Practice Address - Street 2:304N
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3302
Practice Address - Country:US
Practice Address - Phone:562-490-0210
Practice Address - Fax:562-427-0270
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6251225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner