Individual
EDWARD KEVIN MIZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1414 S TYLER ST, COVINGTON, LA 70433-2334
(985) 894-4622
Mailing address
1414 S TYLER ST, COVINGTON, LA 70433-2334
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
000616
LA
Other
Enumeration date
06/01/2017
Last updated
06/01/2017
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