Individual
JORDAN M MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
822 S AUTO MALL RD, BLOOMINGTON, IN 47401-5430
(812) 668-1781
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05015543A
IN
225100000X
Physical Therapist
PT34857
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT34857
PT LICENSE
FL
Enumeration date
08/07/2019
Last updated
05/27/2024
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