Provider Demographics
NPI:1144848797
Name:LINENKO, KATRINA MARIE (SCAT, ATC)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:LINENKO
Suffix:
Gender:F
Credentials:SCAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 SUBER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-4623
Mailing Address - Country:US
Mailing Address - Phone:541-961-9145
Mailing Address - Fax:
Practice Address - Street 1:300 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9422
Practice Address - Country:US
Practice Address - Phone:180-357-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAT032242255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program