Healthcare Provider Details

I. General information

NPI: 1285839811
Provider Name (Legal Business Name): LYNN'S PERFECT FIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2838 HICKORY HILL RD SUITE 28
MEMPHIS TN
38115-2173
US

IV. Provider business mailing address

2838 HICKORY HILL RD 28
MEMPHIS TN
38115-2173
US

V. Phone/Fax

Practice location:
  • Phone: 901-546-7572
  • Fax: 901-546-7572
Mailing address:
  • Phone: 901-546-7572
  • Fax: 901-546-7572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCFM01423
License Number StateTN

VIII. Authorized Official

Name: MRS. LINDA FAYE REDDICK
Title or Position: OWNER
Credential: CFM
Phone: 901-546-7572