Healthcare Provider Details

I. General information

NPI: 1578045100
Provider Name (Legal Business Name): LYNDSAY PICHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W WARD ST
SPRINGFIELD OH
45504-2199
US

IV. Provider business mailing address

2015 RED CEDAR DR APT 1D
TIPP CITY OH
45371-7542
US

V. Phone/Fax

Practice location:
  • Phone: 812-584-9780
  • Fax:
Mailing address:
  • Phone: 812-584-9780
  • Fax:

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: