Healthcare Provider Details

I. General information

NPI: 1770693475
Provider Name (Legal Business Name): JILL LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 CENTRAL AVE
SAINT PETERSBURG FL
33710-8510
US

IV. Provider business mailing address

1758 S LAKE AVE
CLEARWATER FL
33756-1826
US

V. Phone/Fax

Practice location:
  • Phone: 727-345-3395
  • Fax:
Mailing address:
  • Phone: 727-584-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: