Healthcare Provider Details

I. General information

NPI: 1194289637
Provider Name (Legal Business Name): LINDSEY TAYLOR HULBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SANTA FE DR
BETHEL PARK PA
15102-1924
US

IV. Provider business mailing address

28 SANTA FE DR
BETHEL PARK PA
15102-1924
US

V. Phone/Fax

Practice location:
  • Phone: 412-584-8787
  • Fax:
Mailing address:
  • Phone: 412-584-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: