Individual
LINDSAY DIVACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7 CRAIG ST, JERICHO, NY 11753-1948
(516) 761-8651
Mailing address
7 CRAIG ST, JERICHO, NY 11753-1948
(516) 761-8651
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
013625
NY
Other
Enumeration date
08/03/2023
Last updated
08/03/2023
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