Provider Demographics
NPI:1871849158
Name:SHIVAR, LINDSAY W (DPT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:W
Last Name:SHIVAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:W
Other - Last Name:SARBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 13269
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3269
Mailing Address - Country:US
Mailing Address - Phone:850-877-8855
Mailing Address - Fax:850-877-7627
Practice Address - Street 1:1891 CAPITAL CIR NE
Practice Address - Street 2:SUITE 2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8407
Practice Address - Country:US
Practice Address - Phone:850-877-8855
Practice Address - Fax:850-877-7627
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010745225100000X
FLPT30231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106822OtherMEDICARE PTAN
FL015004200Medicaid
FLPT30231OtherPT LICENSE