Provider Demographics
NPI:1639113400
Name:MEDOFF, LYNN E (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:E
Last Name:MEDOFF
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 1:1428 N MARIPOSA RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7347
Mailing Address - Country:US
Mailing Address - Phone:928-526-1112
Mailing Address - Fax:928-714-9285
Practice Address - Street 1:1428 N MARIPOSA RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7347
Practice Address - Country:US
Practice Address - Phone:928-526-1112
Practice Address - Fax:928-714-9285
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2595208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ71718Medicare PIN
AZP46226Medicare UPIN