Provider Demographics
NPI:1972710051
Name:KNICKERBOCKER, LINDA SCHAY (PT PHYSICAL THERAPIS)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SCHAY
Last Name:KNICKERBOCKER
Suffix:
Gender:F
Credentials:PT PHYSICAL THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 N ALLEN PL
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7413
Mailing Address - Country:US
Mailing Address - Phone:206-525-0778
Mailing Address - Fax:206-524-3416
Practice Address - Street 1:1218 N ALLEN PL
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7413
Practice Address - Country:US
Practice Address - Phone:206-525-0778
Practice Address - Fax:206-524-3416
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002495225100000X
WAMA00010323225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA122721OtherL & I
WA122721OtherL & I