Provider Demographics
NPI:1902560865
Name:BAXTRON, LINNEA CLAIR
Entity Type:Individual
Prefix:
First Name:LINNEA
Middle Name:CLAIR
Last Name:BAXTRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 GLEBE ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7154
Mailing Address - Country:US
Mailing Address - Phone:812-251-6790
Mailing Address - Fax:
Practice Address - Street 1:2460 GLEBE ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7154
Practice Address - Country:US
Practice Address - Phone:812-251-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005828A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant