Provider Demographics
NPI:1639292394
Name:FLYNN, GILDA ELIZABETH (RPT)
Entity Type:Individual
Prefix:MRS
First Name:GILDA
Middle Name:ELIZABETH
Last Name:FLYNN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7265 PONDERA CIR
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1330
Mailing Address - Country:US
Mailing Address - Phone:818-832-7366
Mailing Address - Fax:818-992-8542
Practice Address - Street 1:7265 PONDERA CIR
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1330
Practice Address - Country:US
Practice Address - Phone:818-832-7366
Practice Address - Fax:818-992-8542
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 7684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 7684Medicare UPIN