Healthcare Provider Details

I. General information

NPI: 1134479090
Provider Name (Legal Business Name): LINDA MARINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SHERMAN RD
ENFIELD CT
06082-4128
US

IV. Provider business mailing address

45 SHERMAN RD
ENFIELD CT
06082-4128
US

V. Phone/Fax

Practice location:
  • Phone: 770-687-6959
  • Fax:
Mailing address:
  • Phone: 770-687-6959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA7500
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: