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NPI Code Detail

MEDICARE: ANDREW MURRAY MITCHELL JR. PTA

MEDICARE: ANDREW MURRAY MITCHELL JR. PTA
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
1225200000XPhysical Therapy AssistantP160787836WA

General Provider Information

NPI Number : 1710490073
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW MURRAY MITCHELL JR. PTA
Provider Business Mailing Address
First Line : 10510 CORAL KEY AVE
Second Line :
City : TAMPA
State : FL
Zip : 33647-3460
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1310 NW DEANE ST
Second Line :
City : PULLMAN
State : WA
Zip : 99163-3705
Country : US
Telephone Number : 509-332-1566
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2017
Last Update Date : 11/08/2017

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