Provider Demographics
NPI:1952489874
Name:LINDHOLM, LINDA ANN (RPT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:LINDHOLM
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 BRETT PL UNIT 120
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-5070
Mailing Address - Country:US
Mailing Address - Phone:310-514-0476
Mailing Address - Fax:310-514-0476
Practice Address - Street 1:1418 BRETT PL UNIT 120
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-5070
Practice Address - Country:US
Practice Address - Phone:310-514-0476
Practice Address - Fax:310-514-0476
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 5463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5463OtherPT LICENSE #