Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4779 | MA |
NPI | 1003262973 |
---|---|
Provider Name | Susan Lindlad |
First Address | Andover, MA 01810-2926 |
Second Address | Wakefield, MA 01880-1322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2016 |
Last Update Date | 10/05/2016 |