Healthcare Provider Details

I. General information

NPI: 1053022657
Provider Name (Legal Business Name): ZEBBIE D MITCHELL III ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20165 KASSERINE WAY
EL PASO TX
79925
US

IV. Provider business mailing address

9300 VISCOUNT BLVD
EL PASO TX
79925-6516
US

V. Phone/Fax

Practice location:
  • Phone: 334-804-8157
  • Fax:
Mailing address:
  • Phone: 334-804-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAT8912
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: