Provider Demographics
NPI:1740624154
Name:HARLAN, LINDSIE CARA-JORDAN (CPHT, LMT)
Entity type:Individual
Prefix:
First Name:LINDSIE
Middle Name:CARA-JORDAN
Last Name:HARLAN
Suffix:
Gender:F
Credentials:CPHT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S RAINBOW BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3001
Mailing Address - Country:US
Mailing Address - Phone:512-810-6653
Mailing Address - Fax:
Practice Address - Street 1:201 S RAINBOW BRIDGE DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3001
Practice Address - Country:US
Practice Address - Phone:512-810-6653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT117533225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist