Provider Demographics
NPI:1700950805
Name:NEWMAN, LINDA S (CMT, LMT, NMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:CMT, LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-1805
Mailing Address - Country:US
Mailing Address - Phone:719-544-3201
Mailing Address - Fax:719-924-8176
Practice Address - Street 1:1401 N ELIZABETH ST
Practice Address - Street 2:SUITE # D
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2158
Practice Address - Country:US
Practice Address - Phone:719-544-3201
Practice Address - Fax:719-924-8276
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5320225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9016OtherAMTA MEMBERSHIP
293849600OtherOFFICE OF WORKERS COMPENSATION PROGRAMS DEPARTMENT OF LABOR PROVIDER NUMBER
CO11181OtherPUEBLOMASSAGETHERAPISTLA
11572957OtherCAQH PROVIDER NUMBER
CO32OtherPUEBLOMASSAGEISTLICENCE