Provider Demographics
NPI:1780051052
Name:PACKARD, LINDSEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:PACKARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 E VILLAGE GREEN CIR STE C
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5500
Mailing Address - Country:US
Mailing Address - Phone:833-233-7875
Mailing Address - Fax:
Practice Address - Street 1:4557 S WESTERN ST STE B4
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-8044
Practice Address - Country:US
Practice Address - Phone:833-233-7875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1264371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist