Healthcare Provider Details

I. General information

NPI: 1881547057
Provider Name (Legal Business Name): MITCHELL J DULIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 NE INDEPENDENCE AVE STE 104
LEES SUMMIT MO
64064-2379
US

IV. Provider business mailing address

2861 NE INDEPENDENCE AVE STE 104
LEES SUMMIT MO
64064-2379
US

V. Phone/Fax

Practice location:
  • Phone: 816-272-8538
  • Fax:
Mailing address:
  • Phone: 816-272-8538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2026003662
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: