MEDICARE: BONNIE MARIE LINQUIST CMT

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	174400000X	Specialist	794-046	WI

General Provider Information

NPI Number	:	1730206640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE MARIE LINQUIST CMT

Provider Business Mailing Address
First Line	:	W12187 STATE ROAD 35
Second Line	:
City	:	PRESCOTT
State	:	WI
Zip	:	54021-7605
Country	:	US
Telephone Number	:	715-262-4777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 N ACRES RD
Second Line	:	SUITE 60
City	:	PRESCOTT
State	:	WI
Zip	:	54021-7038
Country	:	US
Telephone Number	:	715-262-4777
Fax Number	:

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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