Provider Demographics
NPI:1225400781
Name:MITCHELL, LAURA BETH (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 W HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:MC CRORY
Mailing Address - State:AR
Mailing Address - Zip Code:72101-8263
Mailing Address - Country:US
Mailing Address - Phone:870-731-2543
Mailing Address - Fax:870-731-1703
Practice Address - Street 1:139 W HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MC CRORY
Practice Address - State:AR
Practice Address - Zip Code:72101-8263
Practice Address - Country:US
Practice Address - Phone:870-731-2543
Practice Address - Fax:870-731-1703
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist