Healthcare Provider Details
I. General information
NPI: 1881049922
Provider Name (Legal Business Name): HALEY MITCHELL P.T, D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 04/26/2016
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5707 MAIN ST
SPRINGFIELD OR
97478-5426
US
IV. Provider business mailing address
1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US
V. Phone/Fax
- Phone: 866-483-5378
- Fax:
- Phone: 423-238-7217
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | 62370 |
| License Number State | OR |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2251S0007X |
| Taxonomy | Sports Physical Therapist |
| License Number | 62370 |
| License Number State | OR |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | 291238 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: