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General NPI Number Information
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NPI Number | 1992198329
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Entity Type | Individual
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Provider Name | CAROLYN MICHELLE MITCHELL DPT
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Gender | Female
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 5831 N NORTHWEST HWY
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City | CHICAGO
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State | IL
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Zip | 60631-2642
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Country | US
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Telephone | 773-775-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 1049 E WILSON ST SUITE 100
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City | BATAVIA
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State | IL
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Zip | 60510-2474
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Country | US
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Telephone | 630-761-0900
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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 | 070021293
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License Number State | IL
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