MEDICARE: KIMBERLY MITCHELL P.T.

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
1	225100000X	Physical Therapist	031254-1	NY

General Provider Information

NPI Number	:	1649417940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MITCHELL P.T.

Provider Business Mailing Address
First Line	:	251 E 77TH ST
Second Line	:	LOWER LEVEL
City	:	NEW YORK
State	:	NY
Zip	:	10075-2045
Country	:	US
Telephone Number	:	978-270-6616
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 E 77TH ST
Second Line	:	LOWER LEVEL
City	:	NEW YORK
State	:	NY
Zip	:	10075-2045
Country	:	US
Telephone Number	:	978-270-6616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	03/25/2015

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Directions to “ KIMBERLY MITCHELL P.T.” Practice Location

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