Healthcare Provider Details

I. General information

NPI: 1245365964
Provider Name (Legal Business Name): MARIA LINDAHL AT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 LONG RAPIDS PLZ
ALPENA MI
49707-1374
US

IV. Provider business mailing address

348 LONG RAPIDS PLZ
ALPENA MI
49707-1374
US

V. Phone/Fax

Practice location:
  • Phone: 989-358-8086
  • Fax: 989-354-2253
Mailing address:
  • Phone: 989-358-8086
  • Fax: 989-354-2253

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: