Healthcare Provider Details

I. General information

NPI: 1861396244
Provider Name (Legal Business Name): LYNDY RAE VANEENOO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 MAIN ST
LEXINGTON MI
48450-8800
US

IV. Provider business mailing address

3381 DEERWOOD DR
NORTH STREET MI
48049-4407
US

V. Phone/Fax

Practice location:
  • Phone: 810-359-8193
  • Fax: 810-359-8413
Mailing address:
  • Phone: 810-359-8193
  • Fax: 810-359-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502009015
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: