Individual
MITCHELL THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
301 S RIDGE AVE UNIT 301-303, MIDDLETOWN, DE 19709-4650
(302) 888-9480
Mailing address
1311 MAMARONECK AVE STE 140, WHITE PLAINS, NY 10605-5224
(914) 294-4050
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
21363
MD
225100000X
Physical Therapist
Primary
J10001570
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11779633
CAQH
—
01
—
1861597593
TRICARE CHAMPUS
—
01
—
2859738000
AMERIHEALTH IBC
—
01
—
5070-0082
NCA
—
01
—
62243004
CAREFIRST
—
01
—
J10001570
DE LICENSE
DE
Enumeration date
09/14/2006
Last updated
10/24/2023
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