Healthcare Provider Details

I. General information

NPI: 1801759790
Provider Name (Legal Business Name): CARLA MARIE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

610 CARNATION DR
CLARKS SUMMIT PA
18411-2112
US

V. Phone/Fax

Practice location:
  • Phone: 570-703-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE013167
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: