Provider Demographics
NPI:1386023943
Name:MINK, MEGHON LANAE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MEGHON
Middle Name:LANAE
Last Name:MINK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOUTH MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476
Mailing Address - Country:US
Mailing Address - Phone:870-886-2443
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476
Practice Address - Country:US
Practice Address - Phone:870-886-2443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist