Provider Demographics
NPI:1265761597
Name:HART, LYNDA MARIE (LMP)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:MARIE
Last Name:HART
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 W CANAL DR
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2432
Mailing Address - Country:US
Mailing Address - Phone:509-948-1358
Mailing Address - Fax:
Practice Address - Street 1:3615 W CANAL DR
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2432
Practice Address - Country:US
Practice Address - Phone:509-948-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60095114172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist