Provider Demographics
NPI:1801209754
Name:LYNCH, PENNY (ATC,LAS)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:ATC,LAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 EYE ST NW
Mailing Address - Street 2:GONZAGA COLLEGE HS
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001
Mailing Address - Country:US
Mailing Address - Phone:202-336-7104
Mailing Address - Fax:
Practice Address - Street 1:19 EYE ST NW
Practice Address - Street 2:GONZAGA COLLEGE HS
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001
Practice Address - Country:US
Practice Address - Phone:202-336-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA002982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer