Provider Demographics
NPI:1346338217
Name:MITCHELL, CHRISTOPHER SHAUN (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:SHAUN
Last Name:MITCHELL
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:RR 4 BOX 324
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-4244
Mailing Address - Country:US
Mailing Address - Phone:417-667-5438
Mailing Address - Fax:
Practice Address - Street 1:345 S BARRETT LN
Practice Address - Street 2:STE. 2
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-4255
Practice Address - Country:US
Practice Address - Phone:417-667-6673
Practice Address - Fax:417-667-7733
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist