Provider Demographics
NPI:1104540244
Name:DAWSON, LINDSEY RENEE (PTA, OSC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RENEE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PTA, OSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-7482
Mailing Address - Country:US
Mailing Address - Phone:304-669-1022
Mailing Address - Fax:
Practice Address - Street 1:107 BROWN RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-7482
Practice Address - Country:US
Practice Address - Phone:304-669-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WVPT002257225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant