Healthcare Provider Details

I. General information

NPI: 1487517769
Provider Name (Legal Business Name): MITCHELL STOUGHTON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 CENTRAL AVE E
HAMPTON IA
50441-1869
US

IV. Provider business mailing address

PO BOX 461
NEVADA IA
50201-0461
US

V. Phone/Fax

Practice location:
  • Phone: 641-456-5034
  • Fax: 641-456-5801
Mailing address:
  • Phone: 515-382-3366
  • Fax: 515-382-1576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number131609
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: