Provider Demographics
NPI:1881792018
Name:CROTEAU, LINDA LITTLE (PT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LITTLE
Last Name:CROTEAU
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 1:448 IGNACIO BLVD
Mailing Address - Street 2:#226
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6085
Mailing Address - Country:US
Mailing Address - Phone:415-883-3193
Mailing Address - Fax:415-883-3193
Practice Address - Street 1:487 ENTRADA DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5518
Practice Address - Country:US
Practice Address - Phone:415-883-3193
Practice Address - Fax:415-883-3193
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT126680OtherBLUE SHIELD
CA0PT126681Medicare ID - Type Unspecified