Provider Demographics
NPI:1790258945
Name:LINEBERRY, HAVEN ANTOINETTE (PT)
Entity type:Individual
Prefix:
First Name:HAVEN
Middle Name:ANTOINETTE
Last Name:LINEBERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HAVEN
Other - Middle Name:
Other - Last Name:HELENBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6400 MECHANICSVILLE TPKE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4579
Mailing Address - Country:US
Mailing Address - Phone:804-789-8829
Mailing Address - Fax:
Practice Address - Street 1:169 MADISON AVE STE 15501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5101
Practice Address - Country:US
Practice Address - Phone:385-308-8034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist