Healthcare Provider Details

I. General information

NPI: 1245334465
Provider Name (Legal Business Name): SCOTT DAVID MITCHELL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HIGHWAY 160 S MP 394.3
KAYENTA AZ
86033-0368
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 928-697-4000
  • Fax: 928-697-4052
Mailing address:
  • Phone: 907-729-8901
  • Fax: 907-729-8607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16052
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number198019
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: