Provider Demographics
NPI:1306884390
Name:LINSSEN, ELIZABETH JOAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JOAN
Last Name:LINSSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S 14TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-3478
Mailing Address - Country:US
Mailing Address - Phone:928-634-9518
Mailing Address - Fax:928-646-5404
Practice Address - Street 1:411 S 14TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3478
Practice Address - Country:US
Practice Address - Phone:928-634-9518
Practice Address - Fax:928-646-5404
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ781783001Medicaid
AZ611276600OtherUSDOL FECA
AZAZ0464050OtherBC/BS
AZAZ0464050OtherBC/BS