Healthcare Provider Details

I. General information

NPI: 1376567537
Provider Name (Legal Business Name): LINDA WILMER CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122G AGAPE WAY
STEPHENS CITY VA
22655-2211
US

IV. Provider business mailing address

125 ROSEDALE DR
STEPHENS CITY VA
22655-2343
US

V. Phone/Fax

Practice location:
  • Phone: 540-868-0288
  • Fax:
Mailing address:
  • Phone: 540-869-4097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0019004169
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: