Provider Demographics
NPI:1689825101
Name:SMITH, LYNDA (MT)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 S PADRE ISLAND DR
Mailing Address - Street 2:#13
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5101
Mailing Address - Country:US
Mailing Address - Phone:361-991-4672
Mailing Address - Fax:361-991-4673
Practice Address - Street 1:4455 S PADRE ISLAND DR
Practice Address - Street 2:#13
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5101
Practice Address - Country:US
Practice Address - Phone:361-991-4672
Practice Address - Fax:361-991-4673
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT043104173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist