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NPI Code Detail

MEDICARE: JEFFREY GEORGE MITSCH MSPT

MEDICARE: JEFFREY GEORGE MITSCH MSPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT00009112WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10290933OTHERWADEPT. OF LABOR AND INDUSTRIES
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225096753
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY GEORGE MITSCH MSPT
Provider Business Mailing Address
First Line : 5704 E LAKE SAMMAMISH PKWY SE STE 101
Second Line :
City : ISSAQUAH
State : WA
Zip : 98029-8941
Country : US
Telephone Number : 425-270-3323
Fax Number : 425-270-3326
Provider Business Practice Location Address
First Line : 5704 E LAKE SAMMAMISH PKWY SE STE 101
Second Line :
City : ISSAQUAH
State : WA
Zip : 98029-8941
Country : US
Telephone Number : 425-270-3323
Fax Number : 425-270-3326
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 02/04/2021

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Directions to “ JEFFREY GEORGE MITSCH MSPT” Practice Location

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