Provider Demographics
NPI:1114335403
Name:MITCHELL, DUNCAN THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:DUNCAN
Middle Name:THOMAS
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 SE KING ROAD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-5233
Mailing Address - Country:US
Mailing Address - Phone:503-496-4550
Mailing Address - Fax:503-496-4551
Practice Address - Street 1:MITCHELL PHYSICAL THERAPY
Practice Address - Street 2:4506 SE KING ROAD
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-5233
Practice Address - Country:US
Practice Address - Phone:503-496-4550
Practice Address - Fax:503-496-4551
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2021-07-12
Deactivation Date:2021-06-11
Deactivation Code:
Reactivation Date:2021-07-12
Provider Licenses
StateLicense IDTaxonomies
CA41456174400000X
OR61879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist