Provider Demographics
NPI:1003242074
Name:TOWNSEND, MICKI LYNN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:MICKI
Middle Name:LYNN
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 GIHON RD
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-7112
Mailing Address - Country:US
Mailing Address - Phone:304-615-6335
Mailing Address - Fax:
Practice Address - Street 1:825 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1035
Practice Address - Country:US
Practice Address - Phone:304-927-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-22
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPTA001877225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant