Provider Demographics
NPI:1265670830
Name:SMITH, LINDSAY HANKE (DPT, ATC)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:HANKE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S HORSESHOE RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1696
Mailing Address - Country:US
Mailing Address - Phone:813-952-8804
Mailing Address - Fax:
Practice Address - Street 1:6100 KENNERLY RD STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4379
Practice Address - Country:US
Practice Address - Phone:904-636-5335
Practice Address - Fax:904-636-5330
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist