Provider Demographics
NPI:1558191114
Name:SACK, LINDSAY DAWN
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:DAWN
Last Name:SACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 COUNTY ROAD 65
Mailing Address - Street 2:
Mailing Address - City:KEENESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80643-9104
Mailing Address - Country:US
Mailing Address - Phone:303-709-1008
Mailing Address - Fax:
Practice Address - Street 1:56171 E COLFAX AVE
Practice Address - Street 2:#6
Practice Address - City:STRASBURG
Practice Address - State:CO
Practice Address - Zip Code:80136
Practice Address - Country:US
Practice Address - Phone:303-622-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA0015554225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant