Healthcare Provider Details

I. General information

NPI: 1386818441
Provider Name (Legal Business Name): DONNA LYNN MOULIN LICENSED PHYSICAL TH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 VIRGINIA AVENUE HEARTLAND REHABILITATION SERVICES WYTHEVILLE
WYTHEVILLE VA
24382
US

IV. Provider business mailing address

1403 MILL RACE DRIVE HEARTLAND REHABILITATION SERVICES OF VIRGINIA INC
SALEM VA
24153
US

V. Phone/Fax

Practice location:
  • Phone: 276-228-6200
  • Fax: 276-228-9175
Mailing address:
  • Phone: 540-444-0526
  • Fax: 540-444-0531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306602469
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: