Provider Demographics
NPI:1437927571
Name:ALLEN, MITCHELL L (PTA)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:L
Last Name:ALLEN
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 1:14800 W MOUNTAIN VIEW BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4797
Mailing Address - Country:US
Mailing Address - Phone:623-556-5013
Mailing Address - Fax:623-556-9290
Practice Address - Street 1:14800 W MOUNTAIN VIEW BLVD STE 260
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4797
Practice Address - Country:US
Practice Address - Phone:623-556-5013
Practice Address - Fax:623-556-9290
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-012790225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant