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General NPI Number Information
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NPI Number | 1386023943
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Entity Type | Individual
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Provider Name | MEGHON LANAE MINK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 200 SOUTH MEMORIAL DRIVE
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City | WALNUT RIDGE
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State | AR
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Zip | 72476
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Country | US
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Telephone | 870-886-2443
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Fax |
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Provider Business Mailing Address
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Address Line | 200 SOUTH MEMORIAL DRIVE
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City | WALNUT RIDGE
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State | AR
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Zip | 72476
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Country | US
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Telephone | 870-886-2443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT3991
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License Number State | AR
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