MEDICARE: MRS. TONI DIANE MITCHELL PT

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	PT4880	FL

General Provider Information

NPI Number	:	1821662156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONI DIANE MITCHELL PT

Provider Business Mailing Address
First Line	:	4301 NW 62ND TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3137
Country	:	US
Telephone Number	:	954-821-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1031 SEMINOLE DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3243
Country	:	US
Telephone Number	:	954-780-5627
Fax Number	:

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

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	05/20/2021

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