Healthcare Provider Details

I. General information

NPI: 1801091921
Provider Name (Legal Business Name): LINDSAY MARIE LAVATO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11855 HG TRUEMAN RD
LUSBY MD
20657-2855
US

IV. Provider business mailing address

11855 HG TRUEMAN RD
LUSBY MD
20657-2855
US

V. Phone/Fax

Practice location:
  • Phone: 410-326-3432
  • Fax: 410-326-2493
Mailing address:
  • Phone: 410-326-3432
  • Fax: 410-326-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22300
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: