Healthcare Provider Details

I. General information

NPI: 1568421956
Provider Name (Legal Business Name): LIESL M LINDLEY ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HIGH ST PLYMOUTH STATE UNIVERSITY, MSC # 22
PLYMOUTH NH
03264-1595
US

IV. Provider business mailing address

18 CHURCH ST
BRISTOL NH
03222-3077
US

V. Phone/Fax

Practice location:
  • Phone: 603-535-2928
  • Fax: 603-535-2395
Mailing address:
  • Phone: 603-744-2630
  • Fax: 603-535-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number195
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: