Provider Demographics
NPI:1972746030
Name:MIHAVETZ, LYNDA MICHELE (PT)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:MICHELE
Last Name:MIHAVETZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 COUNTY ROAD 22
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-9478
Mailing Address - Country:US
Mailing Address - Phone:970-240-3119
Mailing Address - Fax:
Practice Address - Street 1:1401 S CASCADE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5003
Practice Address - Country:US
Practice Address - Phone:970-249-9634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-19
Last Update Date:2009-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist