Provider Demographics
NPI:1134973803
Name:LUPO, LINDSEY M (PTA)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:M
Last Name:LUPO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:M
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:119 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1226
Mailing Address - Country:US
Mailing Address - Phone:615-563-5939
Mailing Address - Fax:
Practice Address - Street 1:119 W HIGH ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1226
Practice Address - Country:US
Practice Address - Phone:615-563-5939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7222225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant