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General NPI Number Information
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NPI Number | 1861796799
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Entity Type | Organization
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Legal Business Name | LYNEIL MITCHELL PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 20630 ROUTE 19 SUITE 102
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-6021
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Country | US
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Telephone | 814-881-4717
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Fax |
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Provider Business Mailing Address
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Address Line | 20630 ROUTE 19 SUITE 102
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-6021
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LYNEIL CJ MITCHELL
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Credential | DPT
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Telephone | 814-881-4717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT019593
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License Number State | PA
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