Provider Demographics
NPI:1912285941
Name:LYNN, JEREMY S (LPTA)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:S
Last Name:LYNN
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-3038
Mailing Address - Country:US
Mailing Address - Phone:601-444-0030
Mailing Address - Fax:601-444-0033
Practice Address - Street 1:433 BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3038
Practice Address - Country:US
Practice Address - Phone:601-444-0030
Practice Address - Fax:601-444-0033
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA4864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist