1477967495 NPI number — LINDY PHYSICAL THERAPY LTD

Table of content: (NPI 1477967495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477967495 NPI number — LINDY PHYSICAL THERAPY LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDY PHYSICAL THERAPY LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477967495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 OAK HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEYVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-372-1072
Provider Business Mailing Address Fax Number:
940-243-0173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
519 S. CARROLL BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-372-1072
Provider Business Practice Location Address Fax Number:
940-243-0173
Provider Enumeration Date:
06/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LINDY
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PHYSICAL THERAPIST / OWNER
Authorized Official Telephone Number:
940-372-1072

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  1042182 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1477967495 . This is a "MEDICARE NPI TYPE 2" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1457611899 . This is a "MEDICARE NPI TYPE 1" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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