Healthcare Provider Details

I. General information

NPI: 1376588681
Provider Name (Legal Business Name): STEPHANIE SHIELD LYNCH PT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 N 24TH ST STE 230
PHOENIX AZ
85016-6534
US

IV. Provider business mailing address

3700 N 24TH ST STE 230
PHOENIX AZ
85016-6534
US

V. Phone/Fax

Practice location:
  • Phone: 602-903-4383
  • Fax: 480-782-5213
Mailing address:
  • Phone: 602-903-4383
  • Fax: 480-782-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9440
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: