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General NPI Number Information
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NPI Number | 1790497105
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Entity Type | Individual
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Provider Name | MITCHELL KEVIN RACE MS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 12/16/2022
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 700 LANSDALE AVE
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City | LANSDALE
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State | PA
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Zip | 19446-2962
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Country | US
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Telephone | 267-642-6903
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Fax |
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Provider Business Mailing Address
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Address Line | 56 FRANKLIN AVE
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City | SOUDERTON
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State | PA
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Zip | 18964-1814
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Country | US
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Telephone | 267-642-6903
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT008495
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License Number State | PA
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