Healthcare Provider Details

I. General information

NPI: 1043416720
Provider Name (Legal Business Name): LINDA MORISON HAINES PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON ST BOX 419
BOSTON MA
02111-1526
US

IV. Provider business mailing address

56 GILBERT RD
BELMONT MA
02478-2267
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5632
  • Fax:
Mailing address:
  • Phone: 617-484-0969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2988
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: