Healthcare Provider Details

I. General information

NPI: 1710364559
Provider Name (Legal Business Name): LINDSEY LOVELL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E TYLER ST
LONGVIEW TX
75601-7224
US

IV. Provider business mailing address

10942 FM 726 S
GILMER TX
75645-7430
US

V. Phone/Fax

Practice location:
  • Phone: 903-600-6797
  • Fax:
Mailing address:
  • Phone: 325-665-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2106527
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: