Provider Demographics
NPI:1497249684
Name:VANDER LINDEN, MORGAN (PTA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:VANDER LINDEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 N PEACH AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-8349
Mailing Address - Country:US
Mailing Address - Phone:920-609-6789
Mailing Address - Fax:
Practice Address - Street 1:600 E ELM ST
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405-9682
Practice Address - Country:US
Practice Address - Phone:715-223-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2627-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant