Individual
GREGORY D MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A, L.A.T., A.T.C.
Contact information
Practice address
9732 W WICHITA ST, BOISE, ID 83709-8248
(208) 409-1857
Mailing address
9732 W WICHITA ST, BOISE, ID 83709-8248
(208) 409-1857
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-103
ID
Other
Enumeration date
06/27/2006
Last updated
07/08/2007
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