Provider Demographics
NPI:1619995396
Name:LYNCH, AMY I (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:I
Last Name:LYNCH
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:PO BOX 0897
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-0897
Mailing Address - Country:US
Mailing Address - Phone:360-385-9310
Mailing Address - Fax:360-379-8826
Practice Address - Street 1:27 COLWELL STREET
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339-0897
Practice Address - Country:US
Practice Address - Phone:360-385-9310
Practice Address - Fax:360-379-8826
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8374696OtherDSHS
WA7824409OtherAETNA
WAG8862188OtherMEDICARE GROUP NUMBER
WAA003OtherTRICARE WEST
WA8374696Medicaid
WA5116LYOtherREGENCE BLUE SHIELD
WA8943400OtherCRIME VICTIMS
WA8374696OtherDSHS
WA8943400OtherCRIME VICTIMS