Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306602323 | VA |
NPI | 1013191766 |
---|---|
Provider Name | Lyndsay M Mitchell |
First Address | Radford, VA 24141-2430 |
Second Address | Radford, VA 24141-2430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2007 |
Last Update Date | 18/12/2007 |