Provider Demographics
NPI:1306931647
Name:LINDSEY, CARLEEN (PT MS GCS)
Entity type:Individual
Prefix:MS
First Name:CARLEEN
Middle Name:
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:PT MS GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MAIN ST APT 3J
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-2714
Mailing Address - Country:US
Mailing Address - Phone:860-738-0272
Mailing Address - Fax:860-738-0272
Practice Address - Street 1:1001 FARMINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3990
Practice Address - Country:US
Practice Address - Phone:860-582-8024
Practice Address - Fax:860-585-0609
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11293410OtherCAQH
080002219CT01OtherANTHEM
CT650001017Medicare ID - Type Unspecified