Provider Demographics
NPI:1932917879
Name:LINDSEY, MIKAILA (CMT)
Entity type:Individual
Prefix:
First Name:MIKAILA
Middle Name:
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9315 SUNNYSIDE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-1735
Mailing Address - Country:US
Mailing Address - Phone:510-798-1217
Mailing Address - Fax:
Practice Address - Street 1:9315 SUNNYSIDE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-1735
Practice Address - Country:US
Practice Address - Phone:510-798-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96928225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist