Individual
MRS. EDNA M AYTON-PANAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
3811 PARNELL AVE, FORT WAYNE, IN 46805-1409
(260) 482-4651
Mailing address
4812 BREMEN WAY, FORT WAYNE, IN 46825
(260) 489-1261
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05003023A
IN
2251G0304X
Geriatric Physical Therapist
05003023A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100266090
—
IN
Enumeration date
07/06/2007
Last updated
07/10/2020
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