Provider Demographics
NPI:1114389806
Name:HILYARD, LINDA ELLEN (LMT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ELLEN
Last Name:HILYARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:ELLEN
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:60 BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-9407
Mailing Address - Country:US
Mailing Address - Phone:585-993-2965
Mailing Address - Fax:
Practice Address - Street 1:8201 MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6046
Practice Address - Country:US
Practice Address - Phone:716-970-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27 028511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist