Provider Demographics
NPI:1750686705
Name:LUMSDEN, CAROL (PTA CMT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LUMSDEN
Suffix:
Gender:F
Credentials:PTA CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 S LINDEN RD
Mailing Address - Street 2:STE. B
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4194
Mailing Address - Country:US
Mailing Address - Phone:810-230-9750
Mailing Address - Fax:810-230-8799
Practice Address - Street 1:1397 S LINDEN RD
Practice Address - Street 2:STE. B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4194
Practice Address - Country:US
Practice Address - Phone:810-230-9750
Practice Address - Fax:810-230-8799
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002537225200000X
MI225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant