Provider Demographics
NPI:1285072256
Name:MITCHELL, LONA K
Entity type:Individual
Prefix:
First Name:LONA
Middle Name:K
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 TAMIAMI TRL S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-3160
Mailing Address - Country:US
Mailing Address - Phone:941-492-4462
Mailing Address - Fax:941-492-4497
Practice Address - Street 1:1868 TAMIAMI TRL S
Practice Address - Street 2:SUITE 4
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-3160
Practice Address - Country:US
Practice Address - Phone:941-492-4462
Practice Address - Fax:941-492-4497
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23999225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant