MEDICARE: DR. RAYMOND LOUIS LYNCH PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT012908	GA

General Provider Information

NPI Number	:	1629507165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND LOUIS LYNCH PT, DPT

Provider Business Mailing Address
First Line	:	35 LAURI LN
Second Line	:
City	:	FORTSON
State	:	GA
Zip	:	31808-5074
Country	:	US
Telephone Number	:	706-566-3922
Fax Number	:

Provider Business Practice Location Address
First Line	:	6053 VETERANS PKWY STE 103
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-4663
Country	:	US
Telephone Number	:	706-786-6530
Fax Number	:	706-786-6535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	03/30/2021

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