Provider Demographics
NPI:1225096753
Name:MITSCH, JEFFREY GEORGE (MSPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:GEORGE
Last Name:MITSCH
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5704 E LAKE SAMMAMISH PKWY SE STE 101
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-8941
Mailing Address - Country:US
Mailing Address - Phone:425-270-3323
Mailing Address - Fax:425-270-3326
Practice Address - Street 1:5704 E LAKE SAMMAMISH PKWY SE STE 101
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8941
Practice Address - Country:US
Practice Address - Phone:425-270-3323
Practice Address - Fax:425-270-3326
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0290933OtherDEPT. OF LABOR AND INDUSTRIES
WA8369241Medicaid
WAG8889159Medicare PIN
WA8809111Medicare ID - Type Unspecified
WA8369241Medicaid