=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073924965
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARA LINDSEY PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2014
-----------------------------------------------------
Last Update Date | 05/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 908 26TH ST
-----------------------------------------------------
City | HALEYVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35565-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-485-2213
-----------------------------------------------------
Fax | 205-485-2242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 426 COUNTY HIGHWAY 273
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35570-9535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-269-0374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PTH5858
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------