Healthcare Provider Details

I. General information

NPI: 1760611651
Provider Name (Legal Business Name): ALI S MITCHELL DPT, PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 DURGY HILL RD
WEST RUTLAND VT
05777-9427
US

IV. Provider business mailing address

2338 COUNTY ROUTE 18
WHITEHALL NY
12887-3852
US

V. Phone/Fax

Practice location:
  • Phone: 802-558-2510
  • Fax:
Mailing address:
  • Phone: 802-558-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040.0134048
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number104.0053167
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: