Provider Demographics
NPI:1922663707
Name:WELLENER-LAMBERT, LYNN ALLYSON
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ALLYSON
Last Name:WELLENER-LAMBERT
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 1:406 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-1334
Mailing Address - Country:US
Mailing Address - Phone:267-905-4466
Mailing Address - Fax:
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:PA
Practice Address - Zip Code:18962
Practice Address - Country:US
Practice Address - Phone:267-905-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA004376225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004376OtherWORKMANS COMP CAR ACCIDENT