Basic Information
| Provider Information | |||||||||
| NPI: | 1770011512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYNCH | ||||||||
| FirstName: | JESSICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WALPOLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020813717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086688900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 670 LINWOOD AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | WHITINSVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015882068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082347544 | ||||||||
| FaxNumber: | 5082348002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2017 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.