Provider Demographics
NPI:1437717733
Name:LINDQUIST, IRENE
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:LINDQUIST
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 1:19385 CYPRESS RIDGE TER UNIT 201
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-5163
Mailing Address - Country:US
Mailing Address - Phone:203-526-2420
Mailing Address - Fax:
Practice Address - Street 1:19385 CYPRESS RIDGE TER UNIT 201
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5163
Practice Address - Country:US
Practice Address - Phone:203-526-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty