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NPI Code Detail

MEDICARE: TONI KATHLEEN FLYNN LPT

MEDICARE: TONI KATHLEEN FLYNN LPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1167G00000XLicensed Psychiatric TechnicianLPT20592CA

General Provider Information

NPI Number : 1255579660
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONI KATHLEEN FLYNN LPT
Provider Business Mailing Address
First Line : 2178 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4535
Country : US
Telephone Number : 805-781-4614
Fax Number :
Provider Business Practice Location Address
First Line : 1585 KANSAS AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93405-7604
Country : US
Telephone Number : 805-781-4614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2009
Last Update Date : 01/23/2009

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Directions to “ TONI KATHLEEN FLYNN LPT” Practice Location

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