Individual
AMANDA LEIGH BLAKE MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
13801 OLDHAM PL, MINT HILL, NC 28227-9512
(704) 701-1781
Mailing address
13801 OLDHAM PL, MINT HILL, NC 28227-9512
(704) 701-1781
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A7951
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A7951
PTA LICENSE
NC
Enumeration date
11/23/2022
Last updated
11/23/2022
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