Provider Demographics
NPI:1801091921
Name:LAVATO, LINDSAY MARIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:MARIE
Last Name:LAVATO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11855 HG TRUEMAN RD
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-2855
Mailing Address - Country:US
Mailing Address - Phone:410-326-3432
Mailing Address - Fax:410-326-2493
Practice Address - Street 1:11855 HG TRUEMAN RD
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-2855
Practice Address - Country:US
Practice Address - Phone:410-326-3432
Practice Address - Fax:410-326-2493
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS888-0015OtherCAREFIRST BC/BS
MDS888-0015OtherCAREFIRST BC/BS
MDR09075Medicare UPIN