Provider Demographics
NPI:1245553254
Name:SHAMBLIN, LINDA K (PTA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:SHAMBLIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17848 456TH AVE
Mailing Address - Street 2:
Mailing Address - City:CASTLEWOOD
Mailing Address - State:SD
Mailing Address - Zip Code:57223-5212
Mailing Address - Country:US
Mailing Address - Phone:605-376-0690
Mailing Address - Fax:
Practice Address - Street 1:17848 456TH AVE
Practice Address - Street 2:
Practice Address - City:CASTLEWOOD
Practice Address - State:SD
Practice Address - Zip Code:57223-5212
Practice Address - Country:US
Practice Address - Phone:605-376-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1973225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant