Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT00002430 WA | WA |
N | 2251N0400X | Physical Therapist - Neurology | PT00002430 WA | WA |
N | 2251S0007X | Physical Therapist - Sports | PT00002430 WA | WA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT00002430 WA | WA |
NPI | 1114925948 |
---|---|
Provider Name | William Walter Linnenkohl |
First Address | Tumwater, WA 98512-5684 |
Second Address | Tumwater, WA 98512-5684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0163572 | DEPT LABOR & INDUSTRIES (01) | WA |
1761LI | REGENCE (01) | WA |
8327199 | (05) | WA |