Provider Demographics
NPI:1205950151
Name:LINDER, JACQUELINE MARY (LMT CNMT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARY
Last Name:LINDER
Suffix:
Gender:F
Credentials:LMT CNMT
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 1124
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-1124
Mailing Address - Country:US
Mailing Address - Phone:727-793-9177
Mailing Address - Fax:
Practice Address - Street 1:108 4TH AVE S
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4020
Practice Address - Country:US
Practice Address - Phone:727-793-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA13971225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist