Provider Demographics
NPI:1629614649
Name:DEANG, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:DEANG
Suffix:
Gender:F
Credentials:
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 7439
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-0108
Mailing Address - Country:US
Mailing Address - Phone:813-602-6004
Mailing Address - Fax:813-501-3359
Practice Address - Street 1:2136 ASHLEY OAKS CIR STE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6902
Practice Address - Country:US
Practice Address - Phone:813-602-6004
Practice Address - Fax:813-501-3359
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist