Healthcare Provider Details

I. General information

NPI: 1801601034
Provider Name (Legal Business Name): STEPHEN JAMES MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 20TH ST
VERO BEACH FL
32960-3097
US

IV. Provider business mailing address

PO BOX 431
GRANT FL
32949-0431
US

V. Phone/Fax

Practice location:
  • Phone: 772-567-8585
  • Fax:
Mailing address:
  • Phone: 321-427-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number33769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: