Basic Information
| Provider Information | |||||||||
| NPI: | 1194896266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLYNN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 CATERHAM LN | ||||||||
| Address2: | |||||||||
| City: | SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117331945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316895775 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 356 MIDDLE COUNTRY RD | ||||||||
| Address2: | SECOND FLR STE 210 | ||||||||
| City: | CORAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117274432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317162700 | ||||||||
| FaxNumber: | 6317162782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2006 | ||||||||
| LastUpdateDate: | 04/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 014526 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.