Provider Demographics
NPI:1538293634
Name:LIN, GARY (PT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7811 MONTROSE RD
Mailing Address - Street 2:STE 350
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3359
Mailing Address - Country:US
Mailing Address - Phone:301-213-5700
Mailing Address - Fax:
Practice Address - Street 1:7811 MONTROSE RD
Practice Address - Street 2:STE 350
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3363
Practice Address - Country:US
Practice Address - Phone:301-213-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD172592ZD6TMedicare PIN