MEDICARE: GINA MARIE LINN LPT

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	225100000X	Physical Therapist	1139285	TX

General Provider Information

NPI Number	:	1205920741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MARIE LINN LPT

Provider Business Mailing Address
First Line	:	1317 WHITE DOVE LANE
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210
Country	:	US
Telephone Number	:	940-320-7673
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N. VALLEY PARKWAY
Second Line	:	SUITE 101
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3479
Country	:	US
Telephone Number	:	972-434-6600
Fax Number	:	972-219-5277

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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