Individual
ELIZABETH L TYNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
303 LINWOOD AVE, UNIT 1C, FAIRFIELD, CT 06824-4900
(203) 218-6988
(203) 459-4249
Mailing address
303 LINWOOD AVE, UNIT 1C, FAIRFIELD, CT 06824-4900
(203) 218-6988
(203) 459-4249
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
007056
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750585386
GROUP NPI
CT
01
—
650001421
MEDICARE PTAN
CT
01
—
C03714
GROUP PTAN
CT
Enumeration date
12/01/2006
Last updated
02/25/2015
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