Provider Demographics
NPI:1316017692
Name:BLITZ, MITCHEL LOUIS (PT)
Entity Type:Individual
Prefix:
First Name:MITCHEL
Middle Name:LOUIS
Last Name:BLITZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 CORTLANDT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2632
Mailing Address - Country:US
Mailing Address - Phone:713-522-1726
Mailing Address - Fax:713-522-7163
Practice Address - Street 1:510 WAUGH DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-2002
Practice Address - Country:US
Practice Address - Phone:713-522-1726
Practice Address - Fax:713-522-7163
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1163520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist