Provider Demographics
NPI:1871805549
Name:BADER, LINDSAY L (DPT)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:L
Last Name:BADER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:L
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-0435
Mailing Address - Country:US
Mailing Address - Phone:308-872-5111
Mailing Address - Fax:308-872-5115
Practice Address - Street 1:325 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2213
Practice Address - Country:US
Practice Address - Phone:308-872-5111
Practice Address - Fax:308-872-5115
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$08Medicaid
NE098562003Medicare PIN