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General NPI Number Information
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NPI Number | 1497249684
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Entity Type | Individual
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Provider Name | MORGAN VANDER LINDEN PTA
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Gender | Female
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 600 E ELM ST
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City | ABBOTSFORD
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State | WI
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Zip | 54405-9682
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Country | US
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Telephone | 715-223-8051
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 N PEACH AVE APT 10
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City | MARSHFIELD
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State | WI
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Zip | 54449-8349
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Country | US
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Telephone | 920-609-6789
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2627-19
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License Number State | WI
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