Healthcare Provider Details

I. General information

NPI: 1225582554
Provider Name (Legal Business Name): COURTNEY LINDE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 09/29/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E MAIN ST
HORTONVILLE WI
54944
US

IV. Provider business mailing address

PO BOX 71
HORTONVILLE WI
54944-0071
US

V. Phone/Fax

Practice location:
  • Phone: 920-779-4441
  • Fax:
Mailing address:
  • Phone: 920-779-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13504-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: