Provider Demographics
NPI:1346511789
Name:DONNELLY, LINDSY (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:
First Name:LINDSY
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 LOMALAND DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2810
Mailing Address - Country:US
Mailing Address - Phone:619-849-2914
Mailing Address - Fax:619-849-3215
Practice Address - Street 1:3900 LOMALAND DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2810
Practice Address - Country:US
Practice Address - Phone:619-849-2914
Practice Address - Fax:619-849-3215
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer