Provider Demographics
NPI:1821189861
Name:OPDYKE, LINDSAY (PT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:OPDYKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MACARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2938
Mailing Address - Country:US
Mailing Address - Phone:617-730-5337
Mailing Address - Fax:
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:SUITE 6C
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3885
Practice Address - Country:US
Practice Address - Phone:617-730-5337
Practice Address - Fax:617-730-5461
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA470265OtherTUFTS
MAY68407OtherBLUE CROSS
MA10655873OtherAETNA
MAY69459Medicare ID - Type Unspecified