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General NPI Number Information
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NPI Number | 1699537225
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Entity Type | Individual
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Provider Name | CALEB MITCHELL PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 704 OAK ST STE 100
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City | CADILLAC
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State | MI
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Zip | 49601-2386
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Country | US
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Telephone | 231-875-7443
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Fax |
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Provider Business Mailing Address
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Address Line | 19503 40TH AVE
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City | MARION
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State | MI
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Zip | 49665-8203
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Country | US
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Telephone |
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501303092
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License Number State | MI
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