MEDICARE: MR. JASON CHRISTOPHER MITCHELL MSED, ATC, V, ATL

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	2255A2300X	Athletic Trainer	AT3766	TX

General Provider Information

NPI Number	:	1689792798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON CHRISTOPHER MITCHELL MSED, ATC, V, ATL

Provider Business Mailing Address
First Line	:	8908 SEMMES AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-4828
Country	:	US
Telephone Number	:	210-382-8214
Fax Number	:

Provider Business Practice Location Address
First Line	:	OLD DOMINION UNIVERSITY
Second Line	:	ATHLETIC ADMINISTRATION BUILDING #1113C
City	:	NORFOLK
State	:	VA
Zip	:	23529-0001
Country	:	US
Telephone Number	:	757-683-6462
Fax Number	:	757-683-5445

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	04/18/2014

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