Provider Demographics
NPI:1013575786
Name:LETSINGER, AUDREY E (PT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:E
Last Name:LETSINGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:E
Other - Last Name:CAPELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:509 MED TECH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2579
Mailing Address - Country:US
Mailing Address - Phone:423-302-6567
Mailing Address - Fax:276-591-5477
Practice Address - Street 1:136 BRISTOL EAST RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-5500
Practice Address - Country:US
Practice Address - Phone:276-591-5484
Practice Address - Fax:276-591-5477
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist