Provider Demographics
NPI:1548566474
Name:LINDBLOM, KEVIN C (PT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:LINDBLOM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980545
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95798-0545
Mailing Address - Country:US
Mailing Address - Phone:916-465-3735
Mailing Address - Fax:916-374-9753
Practice Address - Street 1:1550 HARBOR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3830
Practice Address - Country:US
Practice Address - Phone:916-456-3735
Practice Address - Fax:916-456-3735
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist