Healthcare Provider Details

I. General information

NPI: 1699685552
Provider Name (Legal Business Name): NICHOLAS LYN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 N FALLS CIRCLE DR APT 110
LAUDERHILL FL
33319-6841
US

IV. Provider business mailing address

6101 N FALLS CIRCLE DR APT 110
LAUDERHILL FL
33319-6841
US

V. Phone/Fax

Practice location:
  • Phone: 305-606-3227
  • Fax:
Mailing address:
  • Phone: 305-606-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number20296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: