MEDICARE: MITCHELL PIDDISI DPT

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	LPT-33214	AZ
2	225100000X	Physical Therapist
3	225100000X	Physical Therapist	1393329	TX

General Provider Information

NPI Number	:	1821724428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL PIDDISI DPT

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:	517-435-3670

Provider Business Practice Location Address
First Line	:	1750 112TH AVE NE
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3752
Country	:	US
Telephone Number	:	425-289-0381
Fax Number	:

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

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	05/27/2026

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Directions to “ MITCHELL PIDDISI DPT” Practice Location

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