MEDICARE: DR. SHANNON MARIE MITCHEL MD, 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
1	208D00000X	General Practice Physician	N3898	TX
2	225100000X	Physical Therapist	1088805	TX

General Provider Information

NPI Number	:	1760699169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON MARIE MITCHEL MD, PT

Provider Business Mailing Address
First Line	:	3005 S LAMAR BLVD.
Second Line	:	STE # D 109-134
City	:	AUSTIN
State	:	TX
Zip	:	78704-8864
Country	:	US
Telephone Number	:	512-550-5513
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 S LAMAR BLVD
Second Line	:	STE D109-134
City	:	AUSTIN
State	:	TX
Zip	:	78704-8864
Country	:	US
Telephone Number	:	512-550-5513
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	04/28/2011

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