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NPI Code Detail

MEDICARE: DEREK MITCHELL

MEDICARE: DEREK 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
1225100000XPhysical TherapistAZ

General Provider Information

NPI Number : 1366305708
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK MITCHELL
Provider Business Mailing Address
First Line : 1650 LYNDON FARM CT STE 300
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-5005
Country : US
Telephone Number : 726-202-3039
Fax Number : 210-978-5592
Provider Business Practice Location Address
First Line : 4800 N 44TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-3800
Country : US
Telephone Number : 602-808-8989
Fax Number : 602-808-9494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2025
Last Update Date : 12/03/2025

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Directions to “ DEREK MITCHELL ” Practice Location

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