Provider Demographics
NPI:1184443657
Name:BETTS, MINDY LYN (PTA)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:LYN
Last Name:BETTS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:IN
Mailing Address - Zip Code:47355-9083
Mailing Address - Country:US
Mailing Address - Phone:260-251-0614
Mailing Address - Fax:
Practice Address - Street 1:409 SE GREENVILLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-9465
Practice Address - Country:US
Practice Address - Phone:765-584-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003569A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant