Healthcare Provider Details

I. General information

NPI: 1609060516
Provider Name (Legal Business Name): LYNN L HALE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 SPRING GARDEN ST
GREENSBORO NC
27403-2135
US

IV. Provider business mailing address

3601 FIELDGATE RD
GREENSBORO NC
27406-9650
US

V. Phone/Fax

Practice location:
  • Phone: 336-294-3338
  • Fax: 336-294-6696
Mailing address:
  • Phone: 336-674-3326
  • Fax: 336-674-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number3647
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: