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Individual
JEFFREY ALAN MITCHELL
Active
Individual
JEFFREY ALAN MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT37484
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
01
—
650025334
RR MEDICARE PIN
—
01
—
CB5773
RR MEDICARE GROUP
—
Enumeration date
11/14/2006
Last updated
08/10/2018
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