Provider Demographics
NPI:1144201369
Name:HAUSCHILDT, MITCHELL DEAN (MA, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:DEAN
Last Name:HAUSCHILDT
Suffix:
Gender:M
Credentials:MA, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 LUNAR ST
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1759
Mailing Address - Country:US
Mailing Address - Phone:417-732-2843
Mailing Address - Fax:
Practice Address - Street 1:4331 S FREMONT AVE
Practice Address - Street 2:HEALTHTRACKS SPORTS TRAINING CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7328
Practice Address - Country:US
Practice Address - Phone:417-820-5010
Practice Address - Fax:417-820-5022
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020076782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer