Provider Demographics
NPI:1255864492
Name:TONSBERG, LINDA (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:TONSBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-0593
Mailing Address - Country:US
Mailing Address - Phone:307-332-5508
Mailing Address - Fax:307-332-7972
Practice Address - Street 1:100 PUSH ROOT CT
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3460
Practice Address - Country:US
Practice Address - Phone:307-332-5508
Practice Address - Fax:307-332-7972
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist