Provider Demographics
NPI:1215791868
Name:LINEBACK, WILLIAM SERGUEI (DPT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SERGUEI
Last Name:LINEBACK
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 1:16 SWARTSON CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1221
Mailing Address - Country:US
Mailing Address - Phone:518-649-0149
Mailing Address - Fax:
Practice Address - Street 1:7 HEMPHILL PL STE 130
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4482
Practice Address - Country:US
Practice Address - Phone:151-828-9524
Practice Address - Fax:518-289-5294
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic