Healthcare Provider Details

I. General information

NPI: 1003027384
Provider Name (Legal Business Name): LINDA LEA KNEEBONE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47819 331ST ST
JEFFERSON SD
57038-6820
US

IV. Provider business mailing address

47819 331ST ST
JEFFERSON SD
57038-6820
US

V. Phone/Fax

Practice location:
  • Phone: 605-356-3229
  • Fax:
Mailing address:
  • Phone: 605-356-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2413
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: