Provider Demographics
NPI:1275761439
Name:NICHOLSON, LINDSEY BLYTHE BARRETT (DPT)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:BLYTHE BARRETT
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:BLYTHE
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2400 WISTERIA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2689
Mailing Address - Country:US
Mailing Address - Phone:770-982-0102
Mailing Address - Fax:770-982-0130
Practice Address - Street 1:2350 LIMESTONE PKWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2087
Practice Address - Country:US
Practice Address - Phone:770-536-9300
Practice Address - Fax:770-536-9389
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206981225100000X
GAPT009628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I650691Medicare PIN