Provider Demographics
NPI:1194027516
Name:MITRE, LINDA MAY (LMT,CT)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MAY
Last Name:MITRE
Suffix:
Gender:F
Credentials:LMT,CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 CHUKAR ST
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-9398
Mailing Address - Country:US
Mailing Address - Phone:775-513-3575
Mailing Address - Fax:
Practice Address - Street 1:3370 S HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5375
Practice Address - Country:US
Practice Address - Phone:775-513-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT3344225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist