Healthcare Provider Details

I. General information

NPI: 1255727780
Provider Name (Legal Business Name): LINDSEY PEDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16522 KEYSTONE BLVD UNIT N
PARKER CO
80134-3303
US

IV. Provider business mailing address

10157 STONERIDGE TER
PARKER CO
80134-9505
US

V. Phone/Fax

Practice location:
  • Phone: 303-840-7325
  • Fax:
Mailing address:
  • Phone: 505-417-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: