Individual
FONDA RENEE MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
208 LILAC DR, EL DORADO, AR 71730-8318
(870) 918-6675
Mailing address
208 LILAC DR, EL DORADO, AR 71730-8318
(870) 918-6675
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 2313
AR
Other
Enumeration date
11/06/2014
Last updated
11/06/2014
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