Healthcare Provider Details

I. General information

NPI: 1679874424
Provider Name (Legal Business Name): LYNN NALODKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 N STATE ST
OREM UT
84057-2057
US

IV. Provider business mailing address

1711 PIEDMONT AVE
AUSTIN TX
78757-1816
US

V. Phone/Fax

Practice location:
  • Phone: 512-663-1999
  • Fax:
Mailing address:
  • Phone: 512-663-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1137586
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1137586
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: