=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407068984
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNDA JOY TRACHTMAN PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1535 DEERPARK DRIVE
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-993-3222
-----------------------------------------------------
Fax | 714-993-6956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1444 SUNNY CREST DRIVE
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | PT6381
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------