Healthcare Provider Details

I. General information

NPI: 1396286183
Provider Name (Legal Business Name): LINDSAY NOELLE HENNING PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSAY NOELLE SCHULLER

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 W CENTRE AVE
PORTAGE MI
49024-5323
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 269-323-4300
  • Fax:
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019892
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: