Healthcare Provider Details

I. General information

NPI: 1275739617
Provider Name (Legal Business Name): LINDSEY ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4526 BIRCHWOOD AVE
JACKSONVILLE FL
32207-6406
US

IV. Provider business mailing address

4526 BIRCHWOOD AVE
JACKSONVILLE FL
32207-6406
US

V. Phone/Fax

Practice location:
  • Phone: 740-350-5521
  • Fax:
Mailing address:
  • Phone: 740-350-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: