| Doctor Name: | JEREMY MITCHELL |
| NPI Number: | 1003215682 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 10986PT |
| Business Practice Address: | 805 E Walnut Ave Lompoc, CA - 934367027 |
| Business Phone Number: | 8057353714 |
| Business Fax Number: | |
| Mailing Address: | 259 Riverdale Ct Apt 236, CAMARILLO |
| State: | CA |
| Postal Code: | 930127775 |
| Phone Number: | 8054787263 |
| Fax Number: | |
| NPI Enumeration Date: | 08/19/2014 |
| NPI Last Update Date: | 11/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 10986PT |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |