Healthcare Provider Details

I. General information

NPI: 1750922753
Provider Name (Legal Business Name): ALYSSA JEAN LYNCH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21-14 NEWTOWN AVE
ASTORIA NY
11102
US

IV. Provider business mailing address

1479 YORK AVE APT 3S
NEW YORK NY
10075-8837
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-0958
  • Fax:
Mailing address:
  • Phone: 774-571-5061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: