Healthcare Provider Details

I. General information

NPI: 1811276124
Provider Name (Legal Business Name): JENNIFER LYNN LYNCH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LYNN CRUDELL LMT

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 HANCOCK ST STE 2G
BANGOR ME
04401-6573
US

IV. Provider business mailing address

5 WATER ST
NEWPORT ME
04953-3161
US

V. Phone/Fax

Practice location:
  • Phone: 207-990-5711
  • Fax: 207-990-5712
Mailing address:
  • Phone: 207-416-3077
  • Fax: 207-990-5712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT1921
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: