Provider Demographics
NPI:1124374376
Name:NICEWARNER, LINDA BEA ALLEN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:BEA ALLEN
Last Name:NICEWARNER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 JACKSONS CHASE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:VA
Mailing Address - Zip Code:22645-3978
Mailing Address - Country:US
Mailing Address - Phone:540-622-7247
Mailing Address - Fax:
Practice Address - Street 1:544 JACKSONS CHASE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:VA
Practice Address - Zip Code:22645-3978
Practice Address - Country:US
Practice Address - Phone:540-622-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000905225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant