Provider Demographics
NPI:1790099869
Name:ZOSKE, LYNN ADRIENNE (PT)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ADRIENNE
Last Name:ZOSKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LYNN
Other - Middle Name:ADRIENNE
Other - Last Name:POMERANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6090 W CAMINO DE MANANA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-9705
Mailing Address - Country:US
Mailing Address - Phone:520-955-3799
Mailing Address - Fax:520-877-2647
Practice Address - Street 1:4249 W INA RD
Practice Address - Street 2:SUITE 125
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2254
Practice Address - Country:US
Practice Address - Phone:520-297-5837
Practice Address - Fax:520-297-8167
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-01
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2177171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty