Provider Demographics
NPI:1114925948
Name:LINNENKOHL, WILLIAM WALTER (MPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WALTER
Last Name:LINNENKOHL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 MOTTMAN RD SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-5684
Mailing Address - Country:US
Mailing Address - Phone:360-352-5077
Mailing Address - Fax:360-352-5022
Practice Address - Street 1:2755 MOTTMAN RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-5684
Practice Address - Country:US
Practice Address - Phone:360-352-5077
Practice Address - Fax:360-352-5022
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002430 WA225100000X, 2251N0400X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0163572OtherDEPT LABOR & INDUSTRIES
WA1761LIOtherREGENCE
WA8327199Medicaid
WA8327199Medicaid