Provider Demographics
NPI:1144339359
Name:MITCHELL, TRICIA L (DPT, MPT)
Entity type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DPT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 LILY CACHE LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-4600
Mailing Address - Country:US
Mailing Address - Phone:630-226-5110
Mailing Address - Fax:630-226-5120
Practice Address - Street 1:1337 LILY CACHE LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-4600
Practice Address - Country:US
Practice Address - Phone:630-226-5110
Practice Address - Fax:630-226-5120
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
213210Medicare ID - Type Unspecified