Provider Demographics
NPI:1316009749
Name:AJA, LINDA D (PT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:D
Last Name:AJA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:DURGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:84 W MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BERNARDSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01337-9460
Mailing Address - Country:US
Mailing Address - Phone:413-648-0237
Mailing Address - Fax:
Practice Address - Street 1:95 LAUREL STREET
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301
Practice Address - Country:US
Practice Address - Phone:413-774-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist