Provider Demographics
NPI:1619044815
Name:REID, LINDA DILLER (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DILLER
Last Name:REID
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 1:2084 PASEO PRIMERO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-8398
Mailing Address - Country:US
Mailing Address - Phone:505-670-5174
Mailing Address - Fax:
Practice Address - Street 1:4600 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1210
Practice Address - Country:US
Practice Address - Phone:505-343-6320
Practice Address - Fax:505-343-6365
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1084225100000X
CA7160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist