Provider Demographics
NPI:1104058437
Name:KACENJAR, LINDSEY (LINDSEY KACENJAR)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:KACENJAR
Suffix:
Gender:F
Credentials:LINDSEY KACENJAR
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:KACENJAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LINDSEY KACENJAR PT
Mailing Address - Street 1:315 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-2617
Practice Address - Country:US
Practice Address - Phone:216-513-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist