Healthcare Provider Details

I. General information

NPI: 1902822307
Provider Name (Legal Business Name): LINDA ELLEN KOMPARA RKT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

8011 N 11TH ST
PHOENIX AZ
85020-3709
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 602-395-9077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number630
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: