Individual
JAY MITTLIEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
3821 COUNTY ROAD 19 S, MINOT, ND 58701-2249
(701) 509-0589
Mailing address
3821 COUNTY ROAD 19 S, MINOT, ND 58701-2249
(701) 509-0589
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1743959
—
AK
Enumeration date
06/12/2019
Last updated
10/22/2024
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