Healthcare Provider Details

I. General information

NPI: 1619442399
Provider Name (Legal Business Name): LINDSEY JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 W CHESTNUT ST
ROGERS AR
72756-0351
US

IV. Provider business mailing address

702 CRESCENT ST
ROGERS AR
72756-3822
US

V. Phone/Fax

Practice location:
  • Phone: 479-246-0101
  • Fax:
Mailing address:
  • Phone: 479-244-0817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: