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General NPI Number Information
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NPI Number | 1114541851
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Entity Type | Individual
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Provider Name | LINNEA OMHOLT PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 335 N RIVER ST STE 203
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City | BATAVIA
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State | IL
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Zip | 60510-2391
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Country | US
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Telephone | 331-248-3533
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Fax |
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Provider Business Mailing Address
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Address Line | 39W269 E MALLORY DR
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City | GENEVA
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State | IL
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Zip | 60134-4900
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 070.021003
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.021003
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License Number State | IL
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