Individual
MITCHELL THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
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
Update your record
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