Provider Demographics
NPI:1326162728
Name:ANDERSON, LINDA WILSON (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:WILSON
Last Name:ANDERSON
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 1:5185 W 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-8038
Mailing Address - Country:US
Mailing Address - Phone:641-792-5220
Mailing Address - Fax:641-792-4883
Practice Address - Street 1:5185 W 58TH ST N
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-8038
Practice Address - Country:US
Practice Address - Phone:641-792-5220
Practice Address - Fax:641-792-4883
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist