Provider Demographics
NPI:1649634858
Name:MITCHELL, KIMBERLY SANDERS (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SANDERS
Last Name:MITCHELL
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 1:11036 S HUNTER HILL LN
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2926
Mailing Address - Country:US
Mailing Address - Phone:940-367-9499
Mailing Address - Fax:
Practice Address - Street 1:519 S CARROLL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6025
Practice Address - Country:US
Practice Address - Phone:940-372-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649634858Medicare UPIN