Healthcare Provider Details

I. General information

NPI: 1083579312
Provider Name (Legal Business Name): NOELLE SHAHNAZ MITCHELL-JAMAL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NE 16TH AVE
PORTLAND OR
97232-1467
US

IV. Provider business mailing address

11301 SE 10TH ST APT 138
VANCOUVER WA
98664-6125
US

V. Phone/Fax

Practice location:
  • Phone: 503-288-6671
  • Fax:
Mailing address:
  • Phone: 714-261-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65938
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: