Basic Information
| Provider Information | |||||||||
| NPI: | 1194232553 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HISLE | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | HUDSON | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5401 VOGEL RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477157831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124775000 | ||||||||
| FaxNumber: | 8124775002 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 VOGEL RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477157831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124775000 | ||||||||
| FaxNumber: | 8124775002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05012157A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 05012157A | 01 | IN | STATE LICENSE | OTHER | 300000117 | 05 | IN | MEDICAID |