Provider Demographics
NPI:1821593773
Name:MITCHELL, LYNDA (EDD, CTRS, CPRP)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:EDD, CTRS, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 E ELLET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-3506
Mailing Address - Country:US
Mailing Address - Phone:215-901-2681
Mailing Address - Fax:215-248-3699
Practice Address - Street 1:1420 WALNUT ST STE 1350
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4019
Practice Address - Country:US
Practice Address - Phone:215-664-3200
Practice Address - Fax:215-664-3201
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist