Provider Demographics
NPI:1376210484
Name:LYNCH, KYLYN L (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:KYLYN
Middle Name:L
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 GRISWOLD ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3815
Mailing Address - Country:US
Mailing Address - Phone:616-207-3861
Mailing Address - Fax:616-327-6364
Practice Address - Street 1:1232 GRISWOLD ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3815
Practice Address - Country:US
Practice Address - Phone:616-207-3861
Practice Address - Fax:616-327-6364
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501020208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265005151OtherGROUP NPI #2