Basic Information
| Provider Information | |||||||||
| NPI: | 1679773097 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEESAMAN | ||||||||
| FirstName: | LINDSEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8601 EDINBROOK XING | ||||||||
| Address2: | #322 | ||||||||
| City: | BROOKLYN PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554434015 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4080 W BROADWAY AVE | ||||||||
| Address2: | #300 | ||||||||
| City: | ROBBINSDALE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554225604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635330541 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 07/24/2007 | ||||||||
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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 | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.