Provider Demographics
NPI:1053437707
Name:PETERS, LINDIE RAYE (PT)
Entity type:Individual
Prefix:MRS
First Name:LINDIE
Middle Name:RAYE
Last Name:PETERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LINDIE
Other - Middle Name:RAYE
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:9170 GALLERIA CT STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4399
Mailing Address - Country:US
Mailing Address - Phone:239-594-5412
Mailing Address - Fax:239-594-2853
Practice Address - Street 1:9170 GALLERIA CT STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4399
Practice Address - Country:US
Practice Address - Phone:239-594-5412
Practice Address - Fax:239-594-2853
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013294225100000X
FLPT29382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
113326OtherHEALTHLINK PROV ID
7216OtherPERSONALCARE PROV ID
113326OtherHEALTHLINK PROV ID
IL4117OtherHAMP PROV ID
FL106857Medicare UPIN