Provider Demographics
NPI:1801828975
Name:FLANNERY, SEPTEMBRE LYN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:SEPTEMBRE
Middle Name:LYN
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:SEPTEMBRE
Other - Middle Name:LYN
Other - Last Name:NOHLGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1137 VIA MIL CUMBRES
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075
Mailing Address - Country:US
Mailing Address - Phone:858-481-9121
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-552-7487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225100000XOtherPHYSICAL THERAPIST