Provider Demographics
NPI:1124253620
Name:INCE, LINDSAY (PT)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:INCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:192 HALPINE RD STE D
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-7645
Practice Address - Country:US
Practice Address - Phone:240-514-2400
Practice Address - Fax:301-816-6968
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016882225100000X
MD25926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211585039Medicare PIN
IL216859064Medicare PIN