Provider Demographics
NPI:1629098827
Name:DAVIS, LINDA EILEEN (MSPT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:EILEEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:HUNTER
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:302-677-0100
Mailing Address - Fax:
Practice Address - Street 1:1288 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4802
Practice Address - Country:US
Practice Address - Phone:302-677-0100
Practice Address - Fax:302-677-0267
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001917225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
88760518OtherCAREFIRST
1629098827OtherTRICARE
11534468OtherCAQH
DE1629098827Medicaid
2714054000OtherIBC AMERIHEALTH
5070-0072OtherNCA
1629098827OtherTRICARE