Provider Demographics
NPI:1164825212
Name:MESZAROS, MITCHELL (MS, ATC, LAT, CES)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:MESZAROS
Suffix:
Gender:M
Credentials:MS, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 CRAB ORCHARD DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3515
Mailing Address - Country:US
Mailing Address - Phone:301-641-5540
Mailing Address - Fax:
Practice Address - Street 1:1105 CRAB ORCHARD DR APT 2B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3515
Practice Address - Country:US
Practice Address - Phone:301-641-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer