Basic Information
Provider Information
NPI: 1578921680
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PETRLICH
FirstName: LINDSAY
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7595 COUNTY ROAD 236
Address2:  
City: FINDLAY
State: OH
PostalCode: 458408738
CountryCode: US
TelephoneNumber: 4194271984
FaxNumber: 4194272864
Practice Location
Address1: 7595 COUNTY ROAD 236
Address2:  
City: FINDLAY
State: OH
PostalCode: 458408738
CountryCode: US
TelephoneNumber: 4194271984
FaxNumber: 4194272864
Other Information
ProviderEnumerationDate: 02/03/2016
LastUpdateDate: 02/03/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT.016162OHY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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