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
State | License ID | Taxonomies |
---|---|---|
CT | 7499 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CT | 080007499CT03 | Other | ANTHEM BC BS |
CT | 080007499CT01 | Other | ANTHEM BC BS |
CT | 004247161 | Medicaid | |
CT | 080007499CT02 | Other | ANTHEM BC BS |
CT | 650001090 | Medicare PIN |