Provider Demographics
NPI:1225640923
Name:MITCHELL, TAYLOR ROMULUS (DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ROMULUS
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 ALLENS LN STE 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3662
Mailing Address - Country:US
Mailing Address - Phone:910-256-4442
Mailing Address - Fax:910-256-4443
Practice Address - Street 1:1721 ALLENS LN STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3662
Practice Address - Country:US
Practice Address - Phone:910-256-4442
Practice Address - Fax:910-256-4443
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist