Provider Demographics
NPI:1356365456
Name:LYNCH, NATHAN CHARLES (PT, CFCE, CSCS)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:CHARLES
Last Name:LYNCH
Suffix:
Gender:M
Credentials:PT, CFCE, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-0762
Mailing Address - Country:US
Mailing Address - Phone:812-786-4394
Mailing Address - Fax:812-725-1634
Practice Address - Street 1:130 HUNTER STATION WAY, SUITE 201
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172
Practice Address - Country:US
Practice Address - Phone:812-786-4394
Practice Address - Fax:812-725-1634
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007866A225100000X
KYPT004377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist