Provider Demographics
NPI:1942477955
Name:DYCHIU, LYNNOR MORDENO (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNNOR
Middle Name:MORDENO
Last Name:DYCHIU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LYNNOR
Other - Middle Name:FABIO
Other - Last Name:MORDENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3290 N RIDGE RD STE 290
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3657
Mailing Address - Country:US
Mailing Address - Phone:410-750-9006
Mailing Address - Fax:
Practice Address - Street 1:3290 N RIDGE RD STE 290
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3657
Practice Address - Country:US
Practice Address - Phone:410-750-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist