Basic Information
| Provider Information | |||||||||
| NPI: | 1265556245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYNN | ||||||||
| FirstName: | RACHAEL | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13537 BARRETT PARKWAY DRIVE | ||||||||
| Address2: | STE 105 | ||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630215866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148219126 | ||||||||
| FaxNumber: | 3148219142 | ||||||||
| Practice Location | |||||||||
| Address1: | 1047 CENTURY DRIVE | ||||||||
| Address2: | |||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620253772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183073434 | ||||||||
| FaxNumber: | 6183073435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 07/29/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1170141 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 70015156 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2535 | NE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2005010782 | MO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.