Healthcare Provider Details

I. General information

NPI: 1992111454
Provider Name (Legal Business Name): LINDSAY HOWARD ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2014
Last Update Date: 08/08/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LACKAWANNA TRAIL JUNIOR-SENIOR HIGH SCHOOL 28 TUNNEL RD
FACTORYVILLE PA
18419
US

IV. Provider business mailing address

127 W LINE ST APT 2
OLYPHANT PA
18447-2069
US

V. Phone/Fax

Practice location:
  • Phone: 484-318-0019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005812
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: