Provider Demographics
NPI:1902531858
Name:PANNELL, VONTE RISHAUN
Entity Type:Individual
Prefix:
First Name:VONTE
Middle Name:RISHAUN
Last Name:PANNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 PAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-1816
Mailing Address - Country:US
Mailing Address - Phone:434-660-4931
Mailing Address - Fax:
Practice Address - Street 1:6125 PAWNEE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-1816
Practice Address - Country:US
Practice Address - Phone:434-660-4931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer