Healthcare Provider Details

I. General information

NPI: 1831623248
Provider Name (Legal Business Name): LYNETTE TALBOTT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 GLENDALE AVE STE 12
SPARKS NV
89431-5777
US

IV. Provider business mailing address

12612 GREENWOOD DR
TRUCKEE CA
96161-2606
US

V. Phone/Fax

Practice location:
  • Phone: 775-356-8181
  • Fax:
Mailing address:
  • Phone: 530-414-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0987
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: