Provider Demographics
NPI:1710585583
Name:LINDEE, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:LINDEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ROSEBAY DR APT 47
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3340
Mailing Address - Country:US
Mailing Address - Phone:832-631-5796
Mailing Address - Fax:
Practice Address - Street 1:155 ROSEBAY DR APT 47
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3340
Practice Address - Country:US
Practice Address - Phone:832-631-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72697225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist