Provider Demographics
NPI:1760201735
Name:LINDEMUTH, LACEE KAE (LMT)
Entity type:Individual
Prefix:
First Name:LACEE
Middle Name:KAE
Last Name:LINDEMUTH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LACEE
Other - Middle Name:KAE
Other - Last Name:SANDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7338
Mailing Address - Country:US
Mailing Address - Phone:541-531-1911
Mailing Address - Fax:
Practice Address - Street 1:18 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7338
Practice Address - Country:US
Practice Address - Phone:541-531-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28416225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist