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General NPI Number Information
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NPI Number | 1548172695
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Entity Type | Individual
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Provider Name | MIKAYLA LYNN LONG
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Gender | Female
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 2350 OAKDALE BLVD
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City | CORALVILLE
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State | IA
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Zip | 52241-9702
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Country | US
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Telephone | 319-351-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 REDHAWK ST APT 107
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City | CORALVILLE
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State | IA
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Zip | 52241-8510
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Country | US
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Telephone | 151-529-0625
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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 | 137836
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License Number State | IA
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