Healthcare Provider Details

I. General information

NPI: 1104913227
Provider Name (Legal Business Name): MARY ANN LINDELL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 WASHINGTON ST
KINGSBURG CA
93631-1931
US

IV. Provider business mailing address

1746 AVENUE 400
KINGSBURG CA
93631-9117
US

V. Phone/Fax

Practice location:
  • Phone: 559-897-0112
  • Fax: 559-897-0112
Mailing address:
  • Phone: 559-897-7464
  • Fax: 559-897-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: