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General NPI Number Information
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NPI Number | 1649414368
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Entity Type | Individual
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Provider Name | LINDA THIBODEAUX
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Gender | Female
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 2604 US HIGHWAY 69 N
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City | LUFKIN
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State | TX
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Zip | 75904-1060
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Country | US
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Telephone | 936-899-7235
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Fax | 936-899-7237
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Provider Business Mailing Address
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Address Line | 169 SCENIC WAY
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City | ETOILE
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State | TX
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Zip | 75944-7662
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Country | US
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Telephone | 936-404-0843
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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 | 2070212
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License Number State | TX
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