Healthcare Provider Details

I. General information

NPI: 1518370014
Provider Name (Legal Business Name): LINDSEY RUSSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDY RUSSELL

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4617 W 20TH ST UNIT A
GREELEY CO
80634-3207
US

IV. Provider business mailing address

1030 SE WESTERLAND ST
HILLSBORO OR
97123-4794
US

V. Phone/Fax

Practice location:
  • Phone: 970-352-9022
  • Fax:
Mailing address:
  • Phone: 206-915-6785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60440413
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP055592T
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30646
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: