Provider Demographics
NPI:1043793391
Name:MEVERDEN, LINDSAY (CTRS, PTA)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:MEVERDEN
Suffix:
Gender:F
Credentials:CTRS, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0520
Mailing Address - Country:US
Mailing Address - Phone:618-607-4110
Mailing Address - Fax:
Practice Address - Street 1:830 ROWAN RD
Practice Address - Street 2:
Practice Address - City:MAKANDA
Practice Address - State:IL
Practice Address - Zip Code:62958-2849
Practice Address - Country:US
Practice Address - Phone:618-607-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
81666225800000X
IL160.008154225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant