Provider Demographics
NPI:1871098418
Name:LANPHEAR, MINDY RENEE (PT)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:RENEE
Last Name:LANPHEAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48860 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MI
Mailing Address - Zip Code:49064-9659
Mailing Address - Country:US
Mailing Address - Phone:269-584-1972
Mailing Address - Fax:
Practice Address - Street 1:1200 ELY ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9368
Practice Address - Country:US
Practice Address - Phone:269-673-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist