Provider Demographics
NPI:1760503783
Name:MAUDE, LINDA (RPT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MAUDE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SPLIT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3376
Mailing Address - Country:US
Mailing Address - Phone:203-506-8429
Mailing Address - Fax:
Practice Address - Street 1:52 BEACH RD STE 207
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824
Practice Address - Country:US
Practice Address - Phone:203-255-7000
Practice Address - Fax:203-255-6995
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004398203Medicaid
CTOV1301OtherHEALTHNET
CT080002440CT01OtherBLUE CROSS
CTANC1153OtherOXFORD HEALTH PLANS
CT080002440CT01OtherBLUE CROSS