Provider Demographics
NPI:1578071460
Name:GOODELL, LINDSEY ANNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:ANNE
Last Name:GOODELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:LINDSEY
Other - Middle Name:ANNE
Other - Last Name:BRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1507 REGENT ST
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-4209
Mailing Address - Country:US
Mailing Address - Phone:910-358-7709
Mailing Address - Fax:
Practice Address - Street 1:515 MOE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3821
Practice Address - Country:US
Practice Address - Phone:518-280-4294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-14
Last Update Date:2018-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist