Provider Demographics
NPI:1114280328
Name:LIND, LINDA ANNE (TEACHER)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANNE
Last Name:LIND
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 PARKSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4629
Mailing Address - Country:US
Mailing Address - Phone:516-313-0283
Mailing Address - Fax:
Practice Address - Street 1:571 PARKSIDE BLVD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4629
Practice Address - Country:US
Practice Address - Phone:516-313-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist