Doctor Name: | MRS. NICOLE HEATHER MITCHELL |
NPI Number: | 1215247150 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPT |
License Number: | 5501012809 |
Business Practice Address: | 5832 N Lapeer Rd Ste Abc North Branch, MI - 484618144 |
Business Phone Number: | 8107935282 |
Business Fax Number: | 8107935281 |
Mailing Address: | 790 Remington Blvd, BOLINGBROOK |
State: | IL |
Postal Code: | 604404909 |
Phone Number: | 6302962223 |
Fax Number: | |
NPI Enumeration Date: | 10/13/2010 |
NPI Last Update Date: | 08/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251N0400X |
License Number: | 5501012809 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Neurology |
Taxonomy Definition: |