Provider Demographics
NPI:1104035542
Name:HATFIELD, LINDA JEAN (MSC RPT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:MSC RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21226 TRAMP HARBOR DR SW
Mailing Address - Street 2:
Mailing Address - City:VASHON ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98070-6704
Mailing Address - Country:US
Mailing Address - Phone:206-463-9251
Mailing Address - Fax:206-463-3739
Practice Address - Street 1:21226 TRAMP HARBOR DR SW
Practice Address - Street 2:
Practice Address - City:VASHON ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98070-6704
Practice Address - Country:US
Practice Address - Phone:206-463-9251
Practice Address - Fax:206-463-3739
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7044787Medicaid
WA556221OtherDDD