Healthcare Provider Details

I. General information

NPI: 1982063079
Provider Name (Legal Business Name): LINDSAY ALLEN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W DOMINICK ST
ROME NY
13440-5846
US

IV. Provider business mailing address

200 W DOMINICK ST
ROME NY
13440-5846
US

V. Phone/Fax

Practice location:
  • Phone: 315-339-6536
  • Fax: 315-339-8089
Mailing address:
  • Phone: 315-339-6536
  • Fax: 315-339-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number002711-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: