Provider Demographics
NPI:1831200732
Name:KING, LYNNE MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1833
Mailing Address - Country:US
Mailing Address - Phone:508-358-4900
Mailing Address - Fax:
Practice Address - Street 1:524 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1833
Practice Address - Country:US
Practice Address - Phone:508-358-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA763687OtherTUFTS HEALTH PLAN
MAY69131OtherMEDICARE PTAN
MA626564OtherHARVARD PILGRIM PLAN
MAY67319OtherBLUE CROSS BLUE SHIELD