Healthcare Provider Details

I. General information

NPI: 1114541851
Provider Name (Legal Business Name): LINNEA OMHOLT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 N RIVER ST STE 203
BATAVIA IL
60510-2391
US

IV. Provider business mailing address

39W269 E MALLORY DR
GENEVA IL
60134-4900
US

V. Phone/Fax

Practice location:
  • Phone: 331-248-3533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070.021003
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.021003
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: