Provider Demographics
NPI:1538370648
Name:MANSOUR, LINDA (PTA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER, MACOMB TWP,15979 HALL ROAD
Mailing Address - Street 2:SUITE150
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044
Mailing Address - Country:US
Mailing Address - Phone:586-416-8430
Mailing Address - Fax:586-416-8440
Practice Address - Street 1:MEDICAL CENTER, MACOMB TWP, 15979 HALL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044
Practice Address - Country:US
Practice Address - Phone:586-416-8430
Practice Address - Fax:586-416-8440
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant