Healthcare Provider Details

I. General information

NPI: 1396751517
Provider Name (Legal Business Name): LYNNE ALICIA RYDEN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 SEVERIN DR
LA MESA CA
91942-3806
US

IV. Provider business mailing address

5905 SEVERIN DR
LA MESA CA
91942-3806
US

V. Phone/Fax

Practice location:
  • Phone: 619-589-2606
  • Fax: 619-464-0900
Mailing address:
  • Phone: 619-589-2606
  • Fax: 619-464-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 6442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: