Basic Information
| Provider Information | |||||||||
| NPI: | 1285394387 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINDSLEY | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | ALEXANDER | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1616 N CENTRAL AVE APT 2370 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4358304599 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4600 S PARK AVE STE 5 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857141697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208899574 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2021 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | LPT-32159 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.