Provider Demographics
NPI:1609093715
Name:GRIFFIN, LYNETTE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:MARIE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-9511
Mailing Address - Country:US
Mailing Address - Phone:248-627-4536
Mailing Address - Fax:
Practice Address - Street 1:1660 S ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8819
Practice Address - Country:US
Practice Address - Phone:248-627-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist