Provider Demographics
NPI:1932284551
Name:HOLMES, LINDSAY (PT, DPT, EDD, MBA)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PT, DPT, EDD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-1662
Mailing Address - Country:US
Mailing Address - Phone:860-805-2643
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080007499CT03OtherANTHEM BC BS
CT080007499CT01OtherANTHEM BC BS
CT004247161Medicaid
CT080007499CT02OtherANTHEM BC BS
CT650001090Medicare PIN