Provider Demographics
NPI:1467563940
Name:WAKEMAN, LINDA F (LMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:F
Last Name:WAKEMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5590 SW 78TH ST
Mailing Address - Street 2:APT D
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5641
Mailing Address - Country:US
Mailing Address - Phone:305-661-1339
Mailing Address - Fax:
Practice Address - Street 1:5590 SW 78TH ST
Practice Address - Street 2:APT D
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5641
Practice Address - Country:US
Practice Address - Phone:305-661-1339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA12991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist