Provider Demographics
NPI:1861796799
Name:LYNEIL MITCHELL PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:LYNEIL MITCHELL PHYSICAL THERAPY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNEIL
Authorized Official - Middle Name:CJ
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:814-881-4717
Mailing Address - Street 1:20630 ROUTE 19
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20630 ROUTE 19
Practice Address - Street 2:SUITE 102
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6021
Practice Address - Country:US
Practice Address - Phone:814-881-4717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019593261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy