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General NPI Number Information
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NPI Number | 1780369074
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Entity Type | Individual
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Provider Name | LISA P. MITCHELL LMT, MLD-C
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Gender | Female
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 1 OLD COUNTRY ROAD, SUITE 102 C/O LISA MITCHELL, SUITE 408
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City | GARDEN CITY
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State | NY
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Zip | 11530
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Country | US
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Telephone | 516-885-6011
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Fax |
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Provider Business Mailing Address
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Address Line | 68 WEATHERBY LN
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722-4549
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Country | US
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Telephone | 516-885-6011
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 030106-02
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License Number State | NY
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