Provider Demographics
NPI:1275784357
Name:MITCHELL, DAVID T (MAOM, LMBT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MAOM, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 COLD STREAM CT APT 108
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-0326
Mailing Address - Country:US
Mailing Address - Phone:828-335-3530
Mailing Address - Fax:
Practice Address - Street 1:1400 COLD STREAM CT APT 108
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-0326
Practice Address - Country:US
Practice Address - Phone:828-335-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003701225700000X
NC15472225700000X
COMT.0019096225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist