Provider Demographics
NPI:1144551342
Name:LINDO, JUSTIN ERNEST (PT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ERNEST
Last Name:LINDO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 FALLS AVE E STE 401
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3455
Mailing Address - Country:US
Mailing Address - Phone:208-994-4300
Mailing Address - Fax:208-417-5160
Practice Address - Street 1:6253 N FOX RUN WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6791
Practice Address - Country:US
Practice Address - Phone:208-994-4300
Practice Address - Fax:208-417-5160
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4161674225100000X
CA36325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26802ZMedicare UPIN