Individual
JONATHAN S MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT,ATC
Contact information
Practice address
129 CORPORATE DR, COVINGTON, LA 70433-1057
(985) 249-6111
(985) 249-6109
Mailing address
129 CORPORATE DR, COVINGTON, LA 70433-1057
(985) 249-6111
(985) 249-6109
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT06910
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT06910
PT LICENSE #
LA
Enumeration date
09/21/2006
Last updated
05/11/2015
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