Provider Demographics
NPI:1861030694
Name:NORDAHL, LINDA (LMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:NORDAHL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-0256
Mailing Address - Country:US
Mailing Address - Phone:404-987-0624
Mailing Address - Fax:
Practice Address - Street 1:145 CHURCH ST NE STE 103
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1691
Practice Address - Country:US
Practice Address - Phone:404-987-0624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT011202225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist