Provider Demographics
NPI:1871650770
Name:KILCULLEN, LINDA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:KILCULLEN
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 380878
Mailing Address - Street 2:
Mailing Address - City:MURDOCK
Mailing Address - State:FL
Mailing Address - Zip Code:33938-0878
Mailing Address - Country:US
Mailing Address - Phone:941-766-1882
Mailing Address - Fax:941-766-1256
Practice Address - Street 1:2101 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2186
Practice Address - Country:US
Practice Address - Phone:941-766-1882
Practice Address - Fax:941-766-1256
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA41234225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2743OtherBCBS