Provider Demographics
NPI:1275032575
Name:PUDER, LINDA K (LMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:PUDER
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 1:111 BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1444
Mailing Address - Country:US
Mailing Address - Phone:814-466-1020
Mailing Address - Fax:
Practice Address - Street 1:111 BOAL AVE
Practice Address - Street 2:
Practice Address - City:BOALSBURG
Practice Address - State:PA
Practice Address - Zip Code:16827-1444
Practice Address - Country:US
Practice Address - Phone:814-466-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist