Provider Demographics
NPI:1912398769
Name:REICHARD, LYNN T
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:T
Last Name:REICHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3965 S MENDENHALL RD STE 20
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-5914
Mailing Address - Country:US
Mailing Address - Phone:901-620-3900
Mailing Address - Fax:
Practice Address - Street 1:3965 S MENDENHALL RD STE 20
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-5914
Practice Address - Country:US
Practice Address - Phone:901-620-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5826225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant