Provider Demographics
NPI:1689643355
Name:FLYNN, ROBERT JAMES (ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:FLYNN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:DWIGHT
Mailing Address - State:IL
Mailing Address - Zip Code:60420-1649
Mailing Address - Country:US
Mailing Address - Phone:815-584-5106
Mailing Address - Fax:
Practice Address - Street 1:301 S WABENA AVE
Practice Address - Street 2:MINOOKA COMMUNITY HIGH SCHOOL
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-9466
Practice Address - Country:US
Practice Address - Phone:815-467-2140
Practice Address - Fax:815-467-7762
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer