NPI 1427297688

Lynette Vanausdale, PTA

Practitioner Physical Therapy Assistant Fairview Heights, IL

Practice location

Address: 141 Market Pl Suite 203, Fairview Heights, IL 62208-2034
Phone: (618) 398-4118
Fax: (847) 881-9640

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X Licence 1400909 (KS)

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Registry record

NPI: 1427297688
Entity type: Individual
Sex (as registered): Female
NPI issued: 11 Feb 2009
Record last updated: 11 Feb 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.