Basic Information
| Provider Information | |||||||||
| NPI: | 1386818441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOULIN | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LICENSED PHYSICAL TH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1403 MILL RACE DRIVE | ||||||||
| Address2: | HEARTLAND REHABILITATION SERVICES OF VIRGINIA INC | ||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404440526 | ||||||||
| FaxNumber: | 5404440531 | ||||||||
| Practice Location | |||||||||
| Address1: | 342 VIRGINIA AVENUE | ||||||||
| Address2: | HEARTLAND REHABILITATION SERVICES WYTHEVILLE | ||||||||
| City: | WYTHEVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762286200 | ||||||||
| FaxNumber: | 2762289175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2008 | ||||||||
| LastUpdateDate: | 04/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2306602469 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.