Provider Demographics
NPI:1932490976
Name:DOUGLAS, LINDA J (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:JERRITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:507 N HIGHWAY 77
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1885
Mailing Address - Country:US
Mailing Address - Phone:972-938-3311
Mailing Address - Fax:
Practice Address - Street 1:507 N HIGHWAY 77
Practice Address - Street 2:SUITE 700
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1885
Practice Address - Country:US
Practice Address - Phone:972-938-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist