Provider Demographics
NPI:1053823708
Name:LINDEMAN, AUDREY MARIE (PT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MARIE
Last Name:LINDEMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:MARIE
Other - Last Name:DIERTIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5825 DELMONICO DR STE 300
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2244
Mailing Address - Country:US
Mailing Address - Phone:719-577-4104
Mailing Address - Fax:
Practice Address - Street 1:8160 W COAL MINE AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123
Practice Address - Country:US
Practice Address - Phone:303-988-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist