Provider Demographics
NPI:1225445356
Name:MITCHELL, JAYE TYLER (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JAYE
Middle Name:TYLER
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 TYSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3421
Mailing Address - Country:US
Mailing Address - Phone:610-353-6286
Mailing Address - Fax:
Practice Address - Street 1:3427 TYSON RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3421
Practice Address - Country:US
Practice Address - Phone:610-353-6286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer