Mary Lynn O'Connor, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT6090 Issued in CA

Practice address

10605 Balboa Blvd
Suite 300
Granada Hills, CA 91344-6342

Phone

(818) 832-7200

Fax

(818) 832-7249

NPI assigned

Apr 26, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mary Lynn O'Connor Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629298377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10765 CREBS AVE",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913262764",
            "telephone_number": "818-366-2588",
            "fax_number": "818-366-2588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10605 BALBOA BLVD",
            "address_2": "SUITE 300",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913446342",
            "telephone_number": "818-832-7200",
            "fax_number": "818-832-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "MARY",
        "middle_name": "LYNN",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT6090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "O'CONNOR",
            "middle_name": "LYNN",
            "credential": "P.T.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Granada Hills, CA
• Providers in Granada Hills, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.