Provider Demographics
NPI:1326319328
Name:VILES, LINNAE (PT)
Entity Type:Individual
Prefix:
First Name:LINNAE
Middle Name:
Last Name:VILES
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 1:950 TAYLOR AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2281
Mailing Address - Country:US
Mailing Address - Phone:616-200-4428
Mailing Address - Fax:616-200-4436
Practice Address - Street 1:950 TAYLOR AVE STE 180
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2281
Practice Address - Country:US
Practice Address - Phone:616-200-4428
Practice Address - Fax:616-200-4436
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist