Individual
MITCHELL LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
328 W VINE ST, EDGERTON, OH 43517-9600
(419) 298-2321
Mailing address
21786 SWITZER RD, DEFIANCE, OH 43512-9732
(740) 975-4464
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA. 08768
OH
Other
Enumeration date
11/22/2012
Last updated
11/22/2012
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