Provider Demographics
NPI:1124104583
Name:BIRDWELL, LINDY LEWIS (PTA)
Entity type:Individual
Prefix:MRS
First Name:LINDY
Middle Name:LEWIS
Last Name:BIRDWELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:LINDY
Other - Middle Name:MICHELLE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:149 APRIL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148
Mailing Address - Country:US
Mailing Address - Phone:615-325-6561
Mailing Address - Fax:
Practice Address - Street 1:370 OLD SHACKLE ISLAND ROAD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-824-0720
Practice Address - Fax:615-824-0272
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA3458225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant