Provider Demographics
NPI:1760404719
Name:LINDE, KEVIN (LPT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:LINDE
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10114 RATCLIFFE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2427
Mailing Address - Country:US
Mailing Address - Phone:703-383-7742
Mailing Address - Fax:703-277-1962
Practice Address - Street 1:3913 OLD LEE HWY
Practice Address - Street 2:SUITE 31C
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2433
Practice Address - Country:US
Practice Address - Phone:703-877-2224
Practice Address - Fax:703-277-1962
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050067342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAJ2990001OtherCARE FIRST
VA192764OtherANTHEM
VA7460488OtherAETNA
VA192764OtherANTHEM