Provider Demographics
NPI:1205977048
Name:PATRICIA, LYNN KAYLEIGH (NCTMB)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:KAYLEIGH
Last Name:PATRICIA
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 UNIVERSITY AVE W STE 160
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1632
Mailing Address - Country:US
Mailing Address - Phone:612-325-3357
Mailing Address - Fax:
Practice Address - Street 1:2375 UNIVERSITY AVE W STE 160
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1632
Practice Address - Country:US
Practice Address - Phone:612-325-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist