Provider Demographics
NPI:1154869295
Name:LINDBLAD, ELIZABETH GORHAM (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GORHAM
Last Name:LINDBLAD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HULL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-6939
Mailing Address - Country:US
Mailing Address - Phone:336-404-3075
Mailing Address - Fax:
Practice Address - Street 1:204 HULL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-6939
Practice Address - Country:US
Practice Address - Phone:336-404-3075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist