1588333975 NPI number — LINDSAY MARIE GOCKENBACH PT, DPT

Table of content: LINDSAY MARIE GOCKENBACH PT, DPT (NPI 1588333975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588333975 NPI number — LINDSAY MARIE GOCKENBACH PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOCKENBACH
Provider First Name:
LINDSAY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

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:
1588333975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2120 43RD ST SE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-238-2259
Provider Business Mailing Address Fax Number:
888-209-9322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 43RD ST SE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-281-1144
Provider Business Practice Location Address Fax Number:
888-209-9322
Provider Enumeration Date:
09/09/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT033230 , registered in the state of PA ; 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)





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