Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 09390 | LA |
NPI | 1013491828 |
---|---|
Provider Name | Lauren Peters Mitchell |
First Address | Natchitoches, LA 71457-0039 |
Second Address | Natchitoches, LA 71457-0039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2018 |
Last Update Date | 18/09/2018 |