Healthcare Provider Details

I. General information

NPI: 1184052151
Provider Name (Legal Business Name): LINDA DAMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 N GARRISON RD
VANCOUVER WA
98664-1354
US

IV. Provider business mailing address

1015 N GARRISON RD
VANCOUVER WA
98664-1354
US

V. Phone/Fax

Practice location:
  • Phone: 360-694-7501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60145574
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: