Provider Demographics
NPI:1114120045
Name:LINNEBACH, HEIDI ANN (MSPT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:LINNEBACH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 MILL ST SE # 1045
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3601
Mailing Address - Country:US
Mailing Address - Phone:503-364-5313
Mailing Address - Fax:503-364-5296
Practice Address - Street 1:1359 N PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-3617
Practice Address - Country:US
Practice Address - Phone:503-982-0232
Practice Address - Fax:503-982-5637
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225100000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR139402Medicare PIN