Healthcare Provider Details

I. General information

NPI: 1205159720
Provider Name (Legal Business Name): LINDSAY K ORNELAS DPT, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 07/21/2022
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 DEERING AVE
PORTLAND ME
04103-4461
US

IV. Provider business mailing address

523 DEERING AVE
PORTLAND ME
04103-4461
US

V. Phone/Fax

Practice location:
  • Phone: 207-653-9178
  • Fax:
Mailing address:
  • Phone: 207-653-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT3588
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT4885
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: