Provider Demographics
NPI:1104600493
Name:LINDER, ETHAN JOHN (DPT)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:JOHN
Last Name:LINDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-1633
Mailing Address - Country:US
Mailing Address - Phone:260-333-0031
Mailing Address - Fax:260-333-0685
Practice Address - Street 1:701 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-1633
Practice Address - Country:US
Practice Address - Phone:260-333-0031
Practice Address - Fax:260-333-0685
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist