Provider Demographics
NPI:1548493224
Name:PANNELL, EVANGELETTE WILSON (LPTA/CWCA)
Entity type:Individual
Prefix:MRS
First Name:EVANGELETTE
Middle Name:WILSON
Last Name:PANNELL
Suffix:
Gender:F
Credentials:LPTA/CWCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4439
Mailing Address - Country:US
Mailing Address - Phone:434-239-6060
Mailing Address - Fax:
Practice Address - Street 1:71 VIKING DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4439
Practice Address - Country:US
Practice Address - Phone:434-239-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001421225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant