Provider Demographics
NPI:1578790846
Name:JUSTIN, LINDA S (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:JUSTIN
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:W4987 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-2435
Mailing Address - Country:US
Mailing Address - Phone:608-788-5275
Mailing Address - Fax:
Practice Address - Street 1:W4987 WOODHAVEN DR
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-2435
Practice Address - Country:US
Practice Address - Phone:608-788-5275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2285-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist