Provider Demographics
NPI:1639137037
Name:ZOLLER-MCKIBBIN, LINDA SUE (ATC PTA)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUE
Last Name:ZOLLER-MCKIBBIN
Suffix:
Gender:F
Credentials:ATC PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BAY DR
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03748
Mailing Address - Country:US
Mailing Address - Phone:603-632-4598
Mailing Address - Fax:
Practice Address - Street 1:125 MASCOMA ST
Practice Address - Street 2:ALICE PECK DAY HOSPITAL
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2647
Practice Address - Country:US
Practice Address - Phone:603-443-9588
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0512225200000X
NH00022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0512OtherPTA LICENSE
NH0002OtherATC LICENSE