Provider Demographics
NPI:1891969333
Name:VERTALKA, LINDSAY (MPT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:VERTALKA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-0218
Mailing Address - Country:US
Mailing Address - Phone:269-795-4230
Mailing Address - Fax:269-795-4191
Practice Address - Street 1:4624 N M 37 HWY STE A
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-8163
Practice Address - Country:US
Practice Address - Phone:269-795-4230
Practice Address - Fax:269-795-4191
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP56980003Medicare PIN
MI0P56980Medicare PIN