Provider Demographics
NPI:1164478988
Name:PEREZ, LINDSAY A (MSPT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:A
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:191 W MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2700
Mailing Address - Country:US
Mailing Address - Phone:585-259-0782
Mailing Address - Fax:585-426-7952
Practice Address - Street 1:191 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2700
Practice Address - Country:US
Practice Address - Phone:585-259-0782
Practice Address - Fax:585-512-8372
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15689225100000X
NY029414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68907Medicare ID - Type Unspecified