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General NPI Number Information
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NPI Number | 1639312507
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Entity Type | Individual
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Provider Name | STEVEN W MITCHELL LMT
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Gender | Male
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 97 INDIA ST
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City | PORTLAND
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State | ME
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Zip | 04101-4248
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Country | US
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Telephone | 207-450-0994
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Fax | 207-799-0794
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Provider Business Mailing Address
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Address Line | 10 DEERING ST APT 3
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City | PORTLAND
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State | ME
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Zip | 04101-2340
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Country | US
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Telephone | 207-450-0994
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Fax | 207-799-0794
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 1658
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License Number State | ME
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