Basic Information
| Provider Information | |||||||||
| NPI: | 1982063079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | LINDSAY | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W DOMINICK ST | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134405846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153396536 | ||||||||
| FaxNumber: | 3153398089 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 W DOMINICK ST | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134405846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153396536 | ||||||||
| FaxNumber: | 3153398089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2016 | ||||||||
| LastUpdateDate: | 02/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 002711-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.