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NPI Code Detail

MEDICARE: JILLIAN MITCHELL PT

MEDICARE: JILLIAN MITCHELL PT
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
1225100000XPhysical TherapistP20090NC
2225100000XPhysical TherapistPT293841CA

General Provider Information

NPI Number : 1134630189
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILLIAN MITCHELL PT
Provider Business Mailing Address
First Line : 408 HIGUERA ST STE 200
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-6135
Country : US
Telephone Number : 805-788-0805
Fax Number : 805-788-0845
Provider Business Practice Location Address
First Line : 4435 EASTGATE MALL STE 120
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-1980
Country : US
Telephone Number : 858-587-8669
Fax Number : 858-587-8675
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2017
Last Update Date : 01/23/2025

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