Basic Information
Provider Information
NPI: 1174886436
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORGAN
FirstName: LINDSAY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ETTINGER
OtherFirstName: LINDSAY
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 201 DEFENSE HWY
Address2: STE 150
City: ANNAPOLIS
State: MD
PostalCode: 214018953
CountryCode: US
TelephoneNumber: 6672047000
FaxNumber: 4434816515
Practice Location
Address1: 2000 MEDICAL PKWY
Address2: STE 101
City: ANNAPOLIS
State: MD
PostalCode: 214013742
CountryCode: US
TelephoneNumber: 4102958900
FaxNumber: 4102804701
Other Information
ProviderEnumerationDate: 06/21/2012
LastUpdateDate: 05/22/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X23861MDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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