Provider Demographics
NPI:1952595746
Name:KREVDA, LINDA FAYE (LMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:FAYE
Last Name:KREVDA
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:PO BOX 358723
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-8723
Mailing Address - Country:US
Mailing Address - Phone:352-219-8222
Mailing Address - Fax:
Practice Address - Street 1:4200 NW 97TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-3742
Practice Address - Country:US
Practice Address - Phone:352-219-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist