Healthcare Provider Details

I. General information

NPI: 1790558500
Provider Name (Legal Business Name): LINDSEY MAYER DPT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 CANYON BLVD STE 150
BOULDER CO
80302-6737
US

IV. Provider business mailing address

2595 CANYON BLVD STE 150
BOULDER CO
80302-6737
US

V. Phone/Fax

Practice location:
  • Phone: 262-515-3905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LINDSEY MAYER
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential:
Phone: 262-515-3905