Basic Information
| Provider Information | |||||||||
| NPI: | 1376588681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYNCH | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | SHIELD | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 N 24TH ST | ||||||||
| Address2: | STE 230 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850166534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029034383 | ||||||||
| FaxNumber: | 4807825213 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 N 24TH ST | ||||||||
| Address2: | STE 230 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850166534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029034383 | ||||||||
| FaxNumber: | 4807825213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 11/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 225100000X | 9440 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.