Provider Demographics
NPI:1376929653
Name:LINSTROM, MELISSA (ATC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LINSTROM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 INDIANA AVE
Mailing Address - Street 2:APT 3313
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-3370
Mailing Address - Country:US
Mailing Address - Phone:818-518-5680
Mailing Address - Fax:
Practice Address - Street 1:1002 CANCER CENTER DR
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0001
Practice Address - Country:US
Practice Address - Phone:818-518-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT63082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer