Provider Demographics
NPI:1447636816
Name:LYNCH, KEEFE (DPT)
Entity type:Individual
Prefix:
First Name:KEEFE
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2388
Mailing Address - Country:US
Mailing Address - Phone:808-373-3555
Mailing Address - Fax:808-373-3666
Practice Address - Street 1:1851 JADWIN AVE APT 307
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2525
Practice Address - Country:US
Practice Address - Phone:541-848-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT4111225100000X
TX1263986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist