Provider Demographics
NPI:1407990930
Name:OTTEN, LINDA DAWN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:DAWN
Last Name:OTTEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:DAWN
Other - Last Name:RITCHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1539 SE 7TH CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5819
Mailing Address - Country:US
Mailing Address - Phone:954-725-0055
Mailing Address - Fax:954-426-8885
Practice Address - Street 1:5026B N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7057
Practice Address - Country:US
Practice Address - Phone:954-426-8884
Practice Address - Fax:954-426-8885
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650951838OtherTAX ID NUMBER
FL650951838OtherTAX ID NUMBER