Provider Demographics
NPI:1841284544
Name:WILLE, LYNN D (ATC/L)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:D
Last Name:WILLE
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MASSACHUSETTS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-4138
Mailing Address - Country:US
Mailing Address - Phone:516-328-1331
Mailing Address - Fax:
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:SUITE LL2
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1886
Practice Address - Country:US
Practice Address - Phone:516-663-9099
Practice Address - Fax:516-663-9092
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0009732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer