Provider Demographics
NPI:1750425906
Name:DISANTI, LYNELLE M
Entity type:Individual
Prefix:
First Name:LYNELLE
Middle Name:M
Last Name:DISANTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNELLE
Other - Middle Name:M
Other - Last Name:OSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 LARDINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-8930
Mailing Address - Country:US
Mailing Address - Phone:724-352-0124
Mailing Address - Fax:
Practice Address - Street 1:5465 WILLIAM FLYNN HWY
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9696
Practice Address - Country:US
Practice Address - Phone:724-444-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008594225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist