Provider Demographics
NPI:1063304103
Name:CORRELL, LINDSAY (LMT)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:
Last Name:CORRELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 BLUEBONNET DR
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1319
Mailing Address - Country:US
Mailing Address - Phone:815-601-8648
Mailing Address - Fax:
Practice Address - Street 1:5518 CLAYTON CIR
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-9533
Practice Address - Country:US
Practice Address - Phone:815-601-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.014706225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty