Provider Demographics
NPI:1164514469
Name:MITZEL, CARA (PT,DPT)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:MITZEL
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 CRESTLAND PL
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6234
Mailing Address - Country:US
Mailing Address - Phone:701-230-3064
Mailing Address - Fax:
Practice Address - Street 1:310 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4515
Practice Address - Country:US
Practice Address - Phone:701-530-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15970Other15970
MN53Q79MIOtherBCBS
MN6407046OtherMEDICA
ND54398Medicaid
MN6407046OtherMEDICA