Provider Demographics
NPI:1417078270
Name:MIXTER, LINDA U (RPT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:U
Last Name:MIXTER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 NILES RD
Mailing Address - Street 2:
Mailing Address - City:AMSTON
Mailing Address - State:CT
Mailing Address - Zip Code:06231-1621
Mailing Address - Country:US
Mailing Address - Phone:860-228-3293
Mailing Address - Fax:
Practice Address - Street 1:60 BOSTON POST RD.
Practice Address - Street 2:GLADEVIEW HEALTH CARE CENTER
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475
Practice Address - Country:US
Practice Address - Phone:860-388-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist