Provider Demographics
NPI:1164173977
Name:KINDIG, LAUREN (PTA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KINDIG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 NW SPRUCE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9521
Mailing Address - Country:US
Mailing Address - Phone:561-318-9784
Mailing Address - Fax:
Practice Address - Street 1:1600 SW CAPRI ST
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-4520
Practice Address - Country:US
Practice Address - Phone:772-223-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24567225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant