Provider Demographics
NPI:1396779740
Name:LYNCH, JENNIFER
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1048
Mailing Address - Street 2:
Mailing Address - City:BUCKINGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4936 YORK ROAD
Practice Address - Street 2:SUITE 1100
Practice Address - City:BUCKINGHAM
Practice Address - State:PA
Practice Address - Zip Code:18912
Practice Address - Country:US
Practice Address - Phone:215-794-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008283-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088503Medicare ID - Type UnspecifiedGROUP #
PA088505Medicare PIN