Healthcare Provider Details

I. General information

NPI: 1255655791
Provider Name (Legal Business Name): TAMERA LYNCH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 VENICE BLVD
LOS ANGELES CA
90034-3216
US

IV. Provider business mailing address

8717 VENICE BLVD
LOS ANGELES CA
90034-3216
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7115
  • Fax: 310-216-6153
Mailing address:
  • Phone: 310-337-7115
  • Fax: 310-216-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: