Provider Demographics
NPI:1861779423
Name:QUIMBY, LYNAE KATHERINE (LMT)
Entity type:Individual
Prefix:
First Name:LYNAE
Middle Name:KATHERINE
Last Name:QUIMBY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HELLER RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:13320-2409
Mailing Address - Country:US
Mailing Address - Phone:518-944-3781
Mailing Address - Fax:
Practice Address - Street 1:571 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:DELANSON
Practice Address - State:NY
Practice Address - Zip Code:12053-5500
Practice Address - Country:US
Practice Address - Phone:518-944-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022886-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist