Provider Demographics
NPI:1790258945
Name:LINEBERRY, HAVEN ANTOINETTE (PT)
Entity Type:Individual
Prefix:
First Name:HAVEN
Middle Name:ANTOINETTE
Last Name:LINEBERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HAVEN
Other - Middle Name:
Other - Last Name:HELENBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6400 MECHANICSVILLE TPKE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4579
Mailing Address - Country:US
Mailing Address - Phone:804-789-8829
Mailing Address - Fax:
Practice Address - Street 1:5211 W BROAD ST STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3000
Practice Address - Country:US
Practice Address - Phone:804-288-3025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist