=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760772404
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHY GIPE MITCHELL PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2011
-----------------------------------------------------
Last Update Date | 04/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 N WASHINGTON AVE
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75246-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-951-8301
-----------------------------------------------------
Fax | 214-820-9369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9002 WOODBLUFF CT
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-6306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-951-8301
-----------------------------------------------------
Fax | 214-820-9369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physical Therapist
-----------------------------------------------------
License Number | 1030013
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------