Basic Information
| Provider Information | |||||||||
| NPI: | 1598960056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOLAN | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | BLAIR | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4301 MACCORKLE AVE SE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253042503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047209185 | ||||||||
| FaxNumber: | 3047209186 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 MACCORKLE AVE SE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253042503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047209185 | ||||||||
| FaxNumber: | 3047209186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2007 | ||||||||
| LastUpdateDate: | 01/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2581 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.