Provider Demographics
NPI:1619523891
Name:LYNCH, DEVIN PAUL (LNMT)
Entity Type:Individual
Prefix:MR
First Name:DEVIN
Middle Name:PAUL
Last Name:LYNCH
Suffix:
Gender:M
Credentials:LNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8178
Mailing Address - Country:US
Mailing Address - Phone:909-793-2225
Mailing Address - Fax:909-793-2221
Practice Address - Street 1:1455 W PARK AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8178
Practice Address - Country:US
Practice Address - Phone:909-793-2225
Practice Address - Fax:909-793-2221
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75964225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10031996OtherWORK COMPENSATION BILLING