Provider Demographics
NPI:1821371279
Name:ROSE, LINDSEY (PTA)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 RHODES ST
Mailing Address - Street 2:
Mailing Address - City:GURDON
Mailing Address - State:AR
Mailing Address - Zip Code:71743-1527
Mailing Address - Country:US
Mailing Address - Phone:870-703-9390
Mailing Address - Fax:
Practice Address - Street 1:106 RHODES ST
Practice Address - Street 2:
Practice Address - City:GURDON
Practice Address - State:AR
Practice Address - Zip Code:71743-1527
Practice Address - Country:US
Practice Address - Phone:870-703-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2515225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant