Provider Demographics
NPI:1861782047
Name:MITCHELL, MISTY MAY (PTA)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:MAY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 S DUMONT DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1641
Mailing Address - Country:US
Mailing Address - Phone:719-671-8954
Mailing Address - Fax:
Practice Address - Street 1:683 S DUMONT DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1641
Practice Address - Country:US
Practice Address - Phone:719-671-8954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant