Provider Demographics
NPI:1831267004
Name:LEBEC, LINDA DESTOUT (PT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:DESTOUT
Last Name:LEBEC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-3723
Mailing Address - Country:US
Mailing Address - Phone:928-282-5050
Mailing Address - Fax:928-282-5945
Practice Address - Street 1:55 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-3723
Practice Address - Country:US
Practice Address - Phone:928-282-5050
Practice Address - Fax:928-282-5945
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ249618Medicaid
AZ115770Medicare PIN