Healthcare Provider Details

I. General information

NPI: 1942435912
Provider Name (Legal Business Name): JONATHAN MIHELLIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1562 CADIZ RD SUITE B
WINTERSVILLE OH
43953-7630
US

IV. Provider business mailing address

25 PAR 3 DRIVE
FOLLANSBEE WV
26037
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-1417
  • Fax: 740-264-9395
Mailing address:
  • Phone: 304-527-7237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT002478W
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013611L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: