Provider Demographics
NPI:1558779587
Name:MEYER, LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 E MORROW AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3026
Mailing Address - Country:US
Mailing Address - Phone:928-753-4263
Mailing Address - Fax:928-753-1173
Practice Address - Street 1:7622 MCLAUGHLIN RD
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4710
Practice Address - Country:US
Practice Address - Phone:719-495-3133
Practice Address - Fax:719-495-8685
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4481225100000X
TN9983225100000X
COPTL.0013575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist