Provider Demographics
NPI:1700934866
Name:GOLDSMITH, LYNDA (PT)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NATIONS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-9169
Mailing Address - Country:US
Mailing Address - Phone:847-263-0480
Mailing Address - Fax:847-263-0590
Practice Address - Street 1:1800 NATIONS DR STE 101
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9169
Practice Address - Country:US
Practice Address - Phone:847-263-0480
Practice Address - Fax:847-263-0590
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK10749Medicare ID - Type Unspecified