MEDICARE: JONATHAN 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	1291287	TX

General Provider Information

NPI Number	:	1508394271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN MITCHELL

Provider Business Mailing Address
First Line	:	5305 WEDDINGTON CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5909
Country	:	US
Telephone Number	:	817-233-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 WEDDINGTON CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5909
Country	:	US
Telephone Number	:	817-233-3500
Fax Number	:

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

Provider Enumeration Date	:	05/25/2017
Last Update Date	:	07/21/2022

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Directions to “ JONATHAN MITCHELL ” Practice Location

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