Provider Demographics
NPI:1720114242
Name:FOOTE, D. LYNN (CMT)
Entity Type:Individual
Prefix:
First Name:D. LYNN
Middle Name:
Last Name:FOOTE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5317
Mailing Address - Country:US
Mailing Address - Phone:410-465-1185
Mailing Address - Fax:
Practice Address - Street 1:5022 DORSEY HALL DR STE 201
Practice Address - Street 2:DORSEY HALL PROFESSIONAL PARK
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7711
Practice Address - Country:US
Practice Address - Phone:410-997-1808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM00469225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist