MEDICARE: MRS. LINDSAY HAZEL BAUTISTA PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	012260	GA

General Provider Information

NPI Number	:	1700355690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDSAY HAZEL BAUTISTA PT, DPT

Provider Business Mailing Address
First Line	:	3380 PEACHTREE RD NE UNIT 814
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1645
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 PEACHTREE RD NE UNIT 814
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1645
Country	:	US
Telephone Number	:	337-309-9493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	11/20/2018

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