Healthcare Provider Details

I. General information

NPI: 1801697628
Provider Name (Legal Business Name): JUSTIN KYLE LINDSEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 NE STEPHENS ST STE 41
ROSEBURG OR
97470-6410
US

IV. Provider business mailing address

1350 NE STEPHENS ST STE 41
ROSEBURG OR
97470-6410
US

V. Phone/Fax

Practice location:
  • Phone: 541-530-0938
  • Fax:
Mailing address:
  • Phone: 541-530-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65377
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: