Provider Demographics
NPI:1477243269
Name:MITCHELL, MADISON KAY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:KAY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:BETHEL HEIGHTS
Mailing Address - State:AR
Mailing Address - Zip Code:72764-8430
Mailing Address - Country:US
Mailing Address - Phone:479-616-0972
Mailing Address - Fax:
Practice Address - Street 1:1062 QUAIL RUN
Practice Address - Street 2:
Practice Address - City:BETHEL HEIGHTS
Practice Address - State:AR
Practice Address - Zip Code:72764-8430
Practice Address - Country:US
Practice Address - Phone:479-616-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist