Individual
JERRY DEWAYNE MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
502 WENDOVER LN, BULLARD, TX 75757-5175
(903) 530-2378
Mailing address
502 WENDOVER LN, BULLARD, TX 75757-5175
(903) 530-2378
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2044733
TX
Other
Enumeration date
09/19/2007
Last updated
09/19/2007
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