Basic Information
| Provider Information | |||||||||
| NPI: | 1114120045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINNEBACH | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | M.S.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 MILL ST SE # 1045 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973013601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033645313 | ||||||||
| FaxNumber: | 5033645296 | ||||||||
| Practice Location | |||||||||
| Address1: | 1359 N PACIFIC HWY | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970713617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039820232 | ||||||||
| FaxNumber: | 5039825637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 225100000X | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.