Provider Demographics
NPI:1437134954
Name:COMSTOCK, LINNEA (PT)
Entity Type:Individual
Prefix:
First Name:LINNEA
Middle Name:
Last Name:COMSTOCK
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 1:165 LILLY RD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5028
Mailing Address - Country:US
Mailing Address - Phone:360-455-8014
Mailing Address - Fax:360-455-8719
Practice Address - Street 1:165 LILLY RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5028
Practice Address - Country:US
Practice Address - Phone:360-455-8014
Practice Address - Fax:360-455-8719
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0147012OtherSTATE DEPT OF LABOR & IND
WAPT00003040OtherSTATE HEALTH DEPT
WA833064Medicaid
WAPT00003040OtherSTATE HEALTH DEPT
WA0147012OtherSTATE DEPT OF LABOR & IND