Provider Demographics
NPI:1255985941
Name:PINTO, LYNDA DIANE
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:DIANE
Last Name:PINTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HAWKS RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-8236
Mailing Address - Country:US
Mailing Address - Phone:817-713-0524
Mailing Address - Fax:
Practice Address - Street 1:105 HAWKS RIDGE TRL
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8236
Practice Address - Country:US
Practice Address - Phone:817-713-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2008645225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant