Basic Information
| Provider Information | |||||||||
| NPI: | 1881993913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINSON | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MHS, PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 845 S MAIN ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549356116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203220447 | ||||||||
| FaxNumber: | 9203221362 | ||||||||
| Practice Location | |||||||||
| Address1: | 845 S MAIN ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549356116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203220447 | ||||||||
| FaxNumber: | 9203221362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2011 | ||||||||
| LastUpdateDate: | 03/15/2011 | ||||||||
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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 | 1542-024 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.