Healthcare Provider Details

I. General information

NPI: 1235703034
Provider Name (Legal Business Name): LINDSAY RENEE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2927 LAKE AVE
FORT WAYNE IN
46805-5415
US

IV. Provider business mailing address

391 ALDERBERRY CT
FORT WAYNE IN
46845-4100
US

V. Phone/Fax

Practice location:
  • Phone: 260-449-1065
  • Fax:
Mailing address:
  • Phone: 260-449-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06003811A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: