Individual
LYNETTE VANAUSDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
141 MARKET PL, SUITE 203, FAIRVIEW HEIGHTS, IL 62208-2034
(618) 398-4118
(847) 881-9640
Mailing address
141 MARKET PL, SUITE 203, FAIRVIEW HEIGHTS, IL 62208-2034
(618) 398-4118
(847) 881-9640
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1400909
KS
Other
Enumeration date
02/11/2009
Last updated
02/11/2009
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