Healthcare Provider Details

I. General information

NPI: 1346781952
Provider Name (Legal Business Name): BRITTANY R. MITCHELL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W CARPENTER ST
SPRINGFIELD IL
62702-4922
US

IV. Provider business mailing address

1025 S 6TH ST
SPRINGFIELD IL
62703-2403
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax: 217-528-6473
Mailing address:
  • Phone: 217-528-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227013775
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: