Provider Demographics
NPI:1669559340
Name:RAYMOND W. LINDEMANN
Entity type:Organization
Organization Name:RAYMOND W. LINDEMANN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-434-0509
Mailing Address - Street 1:1145 LYONS RD # D
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1875
Mailing Address - Country:US
Mailing Address - Phone:937-434-0509
Mailing Address - Fax:937-434-1825
Practice Address - Street 1:1145 LYONS RD # D
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1875
Practice Address - Country:US
Practice Address - Phone:937-434-0509
Practice Address - Fax:937-434-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT1675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000008219OtherANTHEM DME
OH125384133007OtherMMO KETTERING
OH125384133006OtherMMO HH
OH12538413308OtherMMO LEBANON
OH0542283Medicaid
OH365572300OtherUS DEPT OF LABOR
OH125384133003OtherMMO CENTERVILLE
OH126332170675OtherHUMANA
OH000000008218OtherANTHEM
OH125384133007OtherMMO KETTERING
OH126332170675OtherHUMANA
OH=========OtherTRICARE
OH=========OtherTAX ID
OH000000008218OtherANTHEM
OH=========00OtherWORKERS COMPENSATION
OH000000008219OtherANTHEM DME
OH365572300OtherUS DEPT OF LABOR
OH126332170675OtherHUMANA
OH9312523Medicare PIN