Provider Demographics
NPI:1487346201
Name:LINDQUIST, NICOLE ROSEMARIE (DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ROSEMARIE
Last Name:LINDQUIST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-1228
Mailing Address - Country:US
Mailing Address - Phone:856-803-4673
Mailing Address - Fax:
Practice Address - Street 1:1275 S CEDAR CREST BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6207
Practice Address - Country:US
Practice Address - Phone:610-349-2381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist