Provider Demographics
NPI:1427211861
Name:MITCHELL, PAUL ALEX (PTA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALEX
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5073 HALIFAX RD
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-3185
Mailing Address - Country:US
Mailing Address - Phone:919-376-7353
Mailing Address - Fax:
Practice Address - Street 1:621 BERRY HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2207
Practice Address - Country:US
Practice Address - Phone:434-572-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602506225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant