Provider Demographics
NPI:1255573432
Name:REYNOLDS-LYNCH, JULISSA M (PT)
Entity type:Individual
Prefix:MRS
First Name:JULISSA
Middle Name:M
Last Name:REYNOLDS-LYNCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 BLUFFSTONE CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3364
Mailing Address - Country:US
Mailing Address - Phone:832-244-0363
Mailing Address - Fax:
Practice Address - Street 1:3806 BLUFFSTONE CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3364
Practice Address - Country:US
Practice Address - Phone:832-244-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1235080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist