Provider Demographics
NPI:1104913227
Name:LINDELL, MARY ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:LINDELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:1746 AVENUE 400
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-9117
Mailing Address - Country:US
Mailing Address - Phone:559-897-7464
Mailing Address - Fax:559-897-0112
Practice Address - Street 1:1448 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1931
Practice Address - Country:US
Practice Address - Phone:559-897-0112
Practice Address - Fax:559-897-0112
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT1986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT1986OtherLICENSE NUMBER
CAPT1986OtherLICENSE NUMBER