Provider Demographics
NPI:1538485016
Name:LINDSTROM, SHELBY
Entity Type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:
Last Name:LINDSTROM
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 1:1301 HERR LN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4377
Mailing Address - Country:US
Mailing Address - Phone:502-412-9383
Mailing Address - Fax:
Practice Address - Street 1:1301 HERR LN
Practice Address - Street 2:SUITE 120
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4377
Practice Address - Country:US
Practice Address - Phone:502-412-9383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist