Healthcare Provider Details

I. General information

NPI: 1649541236
Provider Name (Legal Business Name): KATHERINE COWINS LINDSEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 WAVERLY LANE
LANEXA VA
23089-9124
US

IV. Provider business mailing address

1701 WAVERLY LANE
LANEXA VA
23089-9124
US

V. Phone/Fax

Practice location:
  • Phone: 757-566-8132
  • Fax:
Mailing address:
  • Phone: 757-566-8132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number2305001217
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: