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General NPI Number Information
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NPI Number | 1861396244
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Entity Type | Individual
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Provider Name | LYNDY RAE VANEENOO PTA
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Gender | Female
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 5730 MAIN ST
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City | LEXINGTON
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State | MI
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Zip | 48450-8800
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Country | US
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Telephone | 810-359-8193
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Fax | 810-359-8413
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Provider Business Mailing Address
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Address Line | 3381 DEERWOOD DR
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City | NORTH STREET
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State | MI
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Zip | 48049-4407
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Country | US
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Telephone | 810-359-8193
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Fax | 810-359-8413
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502009015
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License Number State | MI
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