Healthcare Provider Details

I. General information

NPI: 1124084108
Provider Name (Legal Business Name): LYNN M. MARCHISEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE STREET 19TH FLOOR
ATLANTA GA
30308
US

IV. Provider business mailing address

550 PEACHTREE STREET 19TH FLOOR
ATLANTA GA
30308
US

V. Phone/Fax

Practice location:
  • Phone: 404-215-2050
  • Fax: 404-215-2051
Mailing address:
  • Phone: 404-215-2050
  • Fax: 404-215-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT006169
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: