MEDICARE: MRS. LINDA BEA ALLEN NICEWARNER LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2306000905	VA

General Provider Information

NPI Number	:	1124374376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA BEA ALLEN NICEWARNER LPTA

Provider Business Mailing Address
First Line	:	544 JACKSONS CHASE DR
Second Line	:
City	:	MIDDLETOWN
State	:	VA
Zip	:	22645-3978
Country	:	US
Telephone Number	:	540-622-7247
Fax Number	:

Provider Business Practice Location Address
First Line	:	544 JACKSONS CHASE DR
Second Line	:
City	:	MIDDLETOWN
State	:	VA
Zip	:	22645-3978
Country	:	US
Telephone Number	:	540-622-7247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	07/25/2012

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