Provider Demographics
NPI:1043362122
Name:LINN, KRISTINA LEA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:LEA
Last Name:LINN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10583 NORTH 115TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363
Mailing Address - Country:US
Mailing Address - Phone:623-444-7343
Mailing Address - Fax:
Practice Address - Street 1:8115 EAST INDIAN BEND ROAD
Practice Address - Street 2:SUITE 123
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250
Practice Address - Country:US
Practice Address - Phone:480-951-6451
Practice Address - Fax:480-951-6464
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6198A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant