Provider Demographics
NPI:1497144117
Name:LINZMEIER, JASON PAUL (ATC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:LINZMEIER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 S OXFORD AVE
Mailing Address - Street 2:APT 6
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-2073
Mailing Address - Country:US
Mailing Address - Phone:920-495-4303
Mailing Address - Fax:
Practice Address - Street 1:1300 EGG HARBOR RD
Practice Address - Street 2:SUITE #108
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1277
Practice Address - Country:US
Practice Address - Phone:920-495-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer