MEDICARE: TODD MITCHELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1033793708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD MITCHELL

Provider Business Mailing Address
First Line	:	1379 PLAYERS CLUB CIR
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-3521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12350 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2800
Country	:	US
Telephone Number	:	775-367-6937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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Directions to “ TODD MITCHELL ” Practice Location

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