Provider Demographics
NPI:1386189447
Name:STORY, MITCHELL (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:STORY
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711397
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-1397
Mailing Address - Country:US
Mailing Address - Phone:801-942-2729
Mailing Address - Fax:801-908-7488
Practice Address - Street 1:1179 W PARK LN STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3664
Practice Address - Country:US
Practice Address - Phone:801-640-5284
Practice Address - Fax:801-640-5293
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10188156-8016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist