Provider Demographics
NPI:1093816589
Name:DEHAAS, LINDA LOUISE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LOUISE
Last Name:DEHAAS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:LOUISE
Other - Last Name:ROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, OCS
Mailing Address - Street 1:15141 WHITTIER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2135
Mailing Address - Country:US
Mailing Address - Phone:562-945-1587
Mailing Address - Fax:562-696-9687
Practice Address - Street 1:15141 WHITTIER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2135
Practice Address - Country:US
Practice Address - Phone:562-945-1587
Practice Address - Fax:562-696-9687
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT20964AMedicare ID - Type Unspecified
P54356Medicare UPIN