Healthcare Provider Details

I. General information

NPI: 1417355603
Provider Name (Legal Business Name): LINDSEY CATHERINE SMITH M.S., A.T.C., L.A.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2014
Last Update Date: 12/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WISTERIA PL
MILLBROOK AL
36054-1866
US

IV. Provider business mailing address

34 COUNTY ROAD 544
VERBENA AL
36091-3415
US

V. Phone/Fax

Practice location:
  • Phone: 334-285-0239
  • Fax: 334-285-9689
Mailing address:
  • Phone: 205-389-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1224
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: