Provider Demographics
NPI:1538977491
Name:PRESTON, MITCHELL R
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:R
Last Name:PRESTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 RUE DE LA PRT
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3784
Mailing Address - Country:US
Mailing Address - Phone:732-832-9966
Mailing Address - Fax:
Practice Address - Street 1:1807 RUE DE LA PRT
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3784
Practice Address - Country:US
Practice Address - Phone:732-832-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist