Provider Demographics
NPI:1093242471
Name:MITTERLING, ANTHONY KEITH (DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:KEITH
Last Name:MITTERLING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:KEITH
Other - Last Name:MITTERLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:1001 GATEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0508
Mailing Address - Country:US
Mailing Address - Phone:701-751-3271
Mailing Address - Fax:
Practice Address - Street 1:1001 GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0508
Practice Address - Country:US
Practice Address - Phone:701-751-3271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist