Provider Demographics
NPI:1942330451
Name:WIEBE, LYNN (MSPT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:WIEBE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1518
Mailing Address - Country:US
Mailing Address - Phone:914-631-5977
Mailing Address - Fax:
Practice Address - Street 1:370 ELWOOD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1258
Practice Address - Country:US
Practice Address - Phone:914-769-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist