Individual
MYKALA RAE WISWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
569 MAIN ST, LYNDONVILLE, VT 05851-9240
(802) 626-4224
(802) 748-5024
Mailing address
PO BOX 905, ST JOHNSBURY, VT 05819-0905
(802) 748-8141
(802) 748-4098
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
040.0134189
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3125233
—
NH
05
—
6704637
—
VT
Enumeration date
08/11/2020
Last updated
11/06/2024
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