Healthcare Provider Details

I. General information

NPI: 1639137037
Provider Name (Legal Business Name): LINDA SUE ZOLLER-MCKIBBIN ATC PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MASCOMA ST ALICE PECK DAY HOSPITAL
LEBANON NH
03766-2647
US

IV. Provider business mailing address

3 BAY DR
ENFIELD NH
03748
US

V. Phone/Fax

Practice location:
  • Phone: 603-443-9588
  • Fax:
Mailing address:
  • Phone: 603-632-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0512
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0002
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: