Healthcare Provider Details

I. General information

NPI: 1033317193
Provider Name (Legal Business Name): LINDA IRENE WALLINE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E 6TH AVE
LENNOX SD
57039-2262
US

IV. Provider business mailing address

404 E 6TH AVE
LENNOX SD
57039-2262
US

V. Phone/Fax

Practice location:
  • Phone: 605-647-2251
  • Fax: 605-647-2258
Mailing address:
  • Phone: 605-647-2251
  • Fax: 605-647-2258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number41
License Number StateSD

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: