Provider Demographics
NPI:1760601785
Name:PATTON WALSH, LINDA L (PT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:PATTON WALSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4850 LEMAY FERRY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1576
Mailing Address - Country:US
Mailing Address - Phone:314-416-0439
Mailing Address - Fax:314-487-3062
Practice Address - Street 1:4850 LEMAY FERRY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1576
Practice Address - Country:US
Practice Address - Phone:314-416-1707
Practice Address - Fax:314-416-7184
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO216454426Medicare UPIN