Provider Demographics
NPI:1184014078
Name:FLYNN, BRIAN F (LMT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:F
Last Name:FLYNN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1589
Mailing Address - Street 2:
Mailing Address - City:EL PARDO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-1589
Mailing Address - Country:US
Mailing Address - Phone:575-776-1117
Mailing Address - Fax:575-776-1119
Practice Address - Street 1:98 STATE HIGHWAY 150, SUITE 7
Practice Address - Street 2:
Practice Address - City:EL PARDO
Practice Address - State:NM
Practice Address - Zip Code:87529-1589
Practice Address - Country:US
Practice Address - Phone:575-776-1117
Practice Address - Fax:575-776-1119
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7210225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist