Provider Demographics
NPI:1821209719
Name:RIVERS, LYNN C (PT)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:C
Last Name:RIVERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PORTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1084
Mailing Address - Country:US
Mailing Address - Phone:716-829-7708
Mailing Address - Fax:716-829-8137
Practice Address - Street 1:320 PORTER AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1032
Practice Address - Country:US
Practice Address - Phone:716-829-7708
Practice Address - Fax:716-829-8137
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009270171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor