MEDICARE: MRS. STEFANIA MITCHELL MPT

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	024395	NY

General Provider Information

NPI Number	:	1821294398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEFANIA MITCHELL MPT

Provider Business Mailing Address
First Line	:	67 PACIFIC ST
Second Line	:
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-2911
Country	:	US
Telephone Number	:	516-270-3049
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 PACIFIC ST
Second Line	:
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-2911
Country	:	US
Telephone Number	:	516-270-3049
Fax Number	:

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/08/2007

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