Healthcare Provider Details

I. General information

NPI: 1932744166
Provider Name (Legal Business Name): LINDSEY NICOLE FUJAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 JAMES CASEY ST STE 3C
AUSTIN TX
78745-1120
US

IV. Provider business mailing address

4310 JAMES CASEY ST STE 3C
AUSTIN TX
78745-1120
US

V. Phone/Fax

Practice location:
  • Phone: 512-326-2800
  • Fax: 512-441-6388
Mailing address:
  • Phone: 512-326-2800
  • Fax: 512-441-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1321848
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: