Provider Demographics
NPI:1538197991
Name:MITCHELL, STEPHEN (MSPT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 SE 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5629
Mailing Address - Country:US
Mailing Address - Phone:503-777-1983
Mailing Address - Fax:503-771-1984
Practice Address - Street 1:5212 SE 52ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5629
Practice Address - Country:US
Practice Address - Phone:503-777-1983
Practice Address - Fax:503-771-1984
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR111911Medicare ID - Type Unspecified