MEDICARE: MS. LINDA BLOSSOM P.T.

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	006322	NY

General Provider Information

NPI Number	:	1811964349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA BLOSSOM P.T.

Provider Business Mailing Address
First Line	:	550 LATONA RD
Second Line	:	BLDG. C
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2700
Country	:	US
Telephone Number	:	585-227-3140
Fax Number	:	585-225-7681

Provider Business Practice Location Address
First Line	:	550 LATONA RD
Second Line	:	BLDG. C
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2700
Country	:	US
Telephone Number	:	585-227-3140
Fax Number	:	585-225-7681

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	04/01/2008

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