MEDICARE: THADDEUS DAVID LYNCH PT

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	PT1935	AR

General Provider Information

NPI Number	:	1790866754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THADDEUS DAVID LYNCH PT

Provider Business Mailing Address
First Line	:	140 TIMBERLINE DRIVE
Second Line	:
City	:	BEEBE
State	:	AR
Zip	:	72012
Country	:	US
Telephone Number	:	501-882-3359
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 MARION STREET
Second Line	:	SUITE 102 BAPTIST HEALTH THERAPY CENTER
City	:	SEARCY
State	:	AR
Zip	:	72143
Country	:	US
Telephone Number	:	501-268-2250
Fax Number	:	501-268-2577

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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