Provider Demographics
NPI:1881285161
Name:SMITH, LINSEY MARIE (PTA)
Entity type:Individual
Prefix:
First Name:LINSEY
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 S EMERSON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-1967
Mailing Address - Country:US
Mailing Address - Phone:317-991-5710
Mailing Address - Fax:317-755-1807
Practice Address - Street 1:5135 S EMERSON AVE STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-1967
Practice Address - Country:US
Practice Address - Phone:317-991-5710
Practice Address - Fax:317-755-1807
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06006054A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant