Provider Demographics
NPI:1750487500
Name:CULLUM, LINDA MICHELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MICHELLE
Last Name:CULLUM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:MICHELLE
Other - Last Name:GILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1500 MUSEUM RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4761
Mailing Address - Country:US
Mailing Address - Phone:501-329-3804
Mailing Address - Fax:501-329-0718
Practice Address - Street 1:1500 MUSEUM RD STE 104
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4761
Practice Address - Country:US
Practice Address - Phone:501-329-3804
Practice Address - Fax:501-329-0718
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant