Provider Demographics
NPI:1356710420
Name:PARK, LYNAE ARMITSTEAD (RRT)
Entity type:Individual
Prefix:
First Name:LYNAE
Middle Name:ARMITSTEAD
Last Name:PARK
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 W COBBLE RIDGE DR APT 9108
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-4924
Mailing Address - Country:US
Mailing Address - Phone:801-680-7363
Mailing Address - Fax:
Practice Address - Street 1:3851 W COBBLE RIDGE DR APT 9108
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-4924
Practice Address - Country:US
Practice Address - Phone:801-680-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9178653-5701227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered