Provider Demographics
NPI:1205387222
Name:HARCOURT, LINDA (PTA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HARCOURT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:ABBOTT HARCOURT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:1185 W CARMEL DR BLDG C
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8708
Mailing Address - Country:US
Mailing Address - Phone:317-582-8924
Mailing Address - Fax:
Practice Address - Street 1:1185 W CARMEL DR BLDG C
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8708
Practice Address - Country:US
Practice Address - Phone:317-582-8924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060000558A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant