Provider Demographics
NPI:1184043887
Name:MITTELSTAEDT, DARREL (PT)
Entity Type:Individual
Prefix:MR
First Name:DARREL
Middle Name:
Last Name:MITTELSTAEDT
Suffix:
Gender:M
Credentials:PT
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Other - Last Name:
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Mailing Address - Street 1:6801 MAYFIELD RD
Mailing Address - Street 2:HILLCREST MEDICAL BUILDING #2 SUITE 150
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2270
Mailing Address - Country:US
Mailing Address - Phone:440-312-8529
Mailing Address - Fax:440-312-6928
Practice Address - Street 1:6801 MAYFIELD RD
Practice Address - Street 2:HILLCREST MEDICAL BUILDING #2 SUITE 150
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2270
Practice Address - Country:US
Practice Address - Phone:440-312-8529
Practice Address - Fax:440-312-6928
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHPT-62882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic