Provider Demographics
NPI:1669706164
Name:CREWS, LYNELLE BAYLOR (LMT)
Entity type:Individual
Prefix:
First Name:LYNELLE
Middle Name:BAYLOR
Last Name:CREWS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LYNELLE
Other - Middle Name:FAY
Other - Last Name:BAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:543 SANDY OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-6129
Mailing Address - Country:US
Mailing Address - Phone:386-299-4575
Mailing Address - Fax:
Practice Address - Street 1:142 E GRANADA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6688
Practice Address - Country:US
Practice Address - Phone:386-299-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51141225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist