Provider Demographics
NPI:1114156056
Name:STANLEY, MITCHELL (DPT)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 BALTIMORE ANNAPOLIS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2455
Mailing Address - Country:US
Mailing Address - Phone:410-650-2802
Mailing Address - Fax:410-956-8038
Practice Address - Street 1:1454 BALTIMORE ANNAPOLIS BLVD FL 2
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2455
Practice Address - Country:US
Practice Address - Phone:410-650-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist