Provider Demographics
NPI:1932590049
Name:LYNCH, GAIL (PTA)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11791 WEMBLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROSSMOOR
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4246
Mailing Address - Country:US
Mailing Address - Phone:562-343-3574
Mailing Address - Fax:
Practice Address - Street 1:11791 WEMBLEY RD
Practice Address - Street 2:
Practice Address - City:ROSSMOOR
Practice Address - State:CA
Practice Address - Zip Code:90720-4246
Practice Address - Country:US
Practice Address - Phone:562-343-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT5688225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant