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NPI Code Detail

MEDICARE: JACOB MITCHELL PT

MEDICARE: JACOB MITCHELL PT
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 Therapist1360232TX

General Provider Information

NPI Number : 1275270977
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB MITCHELL PT
Provider Business Mailing Address
First Line : 9660 BARTLETT CIR STE 708
Second Line :
City : FORT WORTH
State : TX
Zip : 76108-4465
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9660 BARTLETT CIR STE 708
Second Line :
City : FORT WORTH
State : TX
Zip : 76108-4465
Country : US
Telephone Number : 817-862-9665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2022
Last Update Date : 05/16/2022

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Directions to “ JACOB MITCHELL PT” Practice Location

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