Provider Demographics
NPI:1194179945
Name:EXTINE, LINDSAY JOY
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:JOY
Last Name:EXTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 MOWERY RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44864-9685
Mailing Address - Country:US
Mailing Address - Phone:419-606-4388
Mailing Address - Fax:
Practice Address - Street 1:1050 MOWERY RD
Practice Address - Street 2:
Practice Address - City:PERRYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44864-9685
Practice Address - Country:US
Practice Address - Phone:419-606-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09115225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant