MEDICARE: JUSTIN LINDA

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	550200037	MI

General Provider Information

NPI Number	:	1356609556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN LINDA

Provider Business Mailing Address
First Line	:	1026 ISABELLA VIS
Second Line	:
City	:	WEIDMAN
State	:	MI
Zip	:	48893-9376
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 ISABELLA VIS
Second Line	:
City	:	WEIDMAN
State	:	MI
Zip	:	48893-9376
Country	:	US
Telephone Number	:	989-313-0754
Fax Number	:

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

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	04/25/2012

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Directions to “ JUSTIN LINDA ” Practice Location

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