Provider Demographics
NPI:1629215017
Name:SOWA, LINDSAY C (MPT)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:C
Last Name:SOWA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:C
Other - Last Name:KRAUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24014 W RENWICK RD STE F
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8708
Mailing Address - Country:US
Mailing Address - Phone:800-974-4378
Mailing Address - Fax:630-515-1536
Practice Address - Street 1:5708 75TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3635
Practice Address - Country:US
Practice Address - Phone:262-697-9135
Practice Address - Fax:262-697-9175
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.016531225100000X
WI12928-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist