Provider Demographics
NPI:1386640928
Name:HAMMANN, LINDA (MS, PT, SCS, ATC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:HAMMANN
Suffix:
Gender:F
Credentials:MS, PT, SCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3009
Mailing Address - Country:US
Mailing Address - Phone:208-336-8250
Mailing Address - Fax:208-336-8250
Practice Address - Street 1:1188 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3009
Practice Address - Country:US
Practice Address - Phone:208-336-8250
Practice Address - Fax:208-336-8250
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT1021OtherBLUE CROSS OF IDAHO #
ID000010008547OtherREGENCE BLUE SHIELD OF ID
ID1652601Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #