Provider Demographics
NPI:1053567057
Name:LYNN DAVIS PT, INC.
Entity type:Organization
Organization Name:LYNN DAVIS PT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-519-8431
Mailing Address - Street 1:2708 SPRING MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4955
Mailing Address - Country:US
Mailing Address - Phone:330-519-8431
Mailing Address - Fax:330-799-3976
Practice Address - Street 1:2708 SPRING MEADOW CIR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4955
Practice Address - Country:US
Practice Address - Phone:330-519-8431
Practice Address - Fax:330-799-3976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA 03719224Z00000X
OHPT - 05599225100000X
OHPT-07469225100000X
OHOT 006691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty