Provider Demographics
NPI:1164619862
Name:WINDEL, MAGEN L (LICENSED PHYSICAL TH)
Entity Type:Individual
Prefix:
First Name:MAGEN
Middle Name:L
Last Name:WINDEL
Suffix:
Gender:F
Credentials:LICENSED PHYSICAL TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 INGLESIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4814
Mailing Address - Country:US
Mailing Address - Phone:540-529-2114
Mailing Address - Fax:
Practice Address - Street 1:1009 OLD COUNTRY CLUB RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-2927
Practice Address - Country:US
Practice Address - Phone:540-387-4311
Practice Address - Fax:540-387-4311
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602172225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant