Provider Demographics
NPI:1760611651
Name:MITCHELL, ALI S (DPT, PT, ATC)
Entity type:Individual
Prefix:MISS
First Name:ALI
Middle Name:S
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DPT, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 COUNTY ROUTE 18
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:NY
Mailing Address - Zip Code:12887-3852
Mailing Address - Country:US
Mailing Address - Phone:802-558-2510
Mailing Address - Fax:
Practice Address - Street 1:171 DURGY HILL RD
Practice Address - Street 2:
Practice Address - City:WEST RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05777-9427
Practice Address - Country:US
Practice Address - Phone:802-558-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.00531672255A2300X
VT040.0134048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer