Provider Demographics
NPI:1295070175
Name:DUVALL, LYNN (LMT LICENSE# 004341-)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:DUVALL
Suffix:
Gender:F
Credentials:LMT LICENSE# 004341-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 WITTENBERG ROAD
Mailing Address - Street 2:
Mailing Address - City:BEARSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12409
Mailing Address - Country:US
Mailing Address - Phone:845-679-6280
Mailing Address - Fax:
Practice Address - Street 1:343 WITTENBERG ROAD
Practice Address - Street 2:
Practice Address - City:BEARSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12409
Practice Address - Country:US
Practice Address - Phone:845-679-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004341-1172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist