1851676712 NPI number — KATHLEEN LINEHAN-JANZEN PHYSICAL THERAPIST

Table of content: LAURIE HRUSKA (NPI 1205171824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851676712 NPI number — KATHLEEN LINEHAN-JANZEN PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINEHAN-JANZEN
Provider First Name:
KATHLEEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINEHAN
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851676712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2270 DOUGLAS BLVD
Provider Second Line Business Mailing Address:
# 112
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95661-3869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-782-1212
Provider Business Mailing Address Fax Number:
916-782-0695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4990 ROCKLIN RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ROCKLIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95677-4315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-632-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  38169 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 4812 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)