Provider Demographics
NPI:1568883817
Name:FREIBOTT, LINDA LEE (CMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:FREIBOTT
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1647
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-1647
Mailing Address - Country:US
Mailing Address - Phone:209-742-4376
Mailing Address - Fax:877-535-1127
Practice Address - Street 1:5211 HILLSIDE DR.
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-1647
Practice Address - Country:US
Practice Address - Phone:209-742-4376
Practice Address - Fax:877-535-1127
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48752225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist