Provider Demographics
NPI:1215476247
Name:CORMACK, LINDA (PT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CORMACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 NW 39TH PL
Mailing Address - Street 2:SUITE D
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7226
Mailing Address - Country:US
Mailing Address - Phone:352-265-5200
Mailing Address - Fax:352-265-5201
Practice Address - Street 1:4740 NW 39TH PL
Practice Address - Street 2:SUITE D
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7226
Practice Address - Country:US
Practice Address - Phone:352-265-5200
Practice Address - Fax:352-265-5201
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0004831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist