Provider Demographics
NPI:1508039926
Name:MITCHELL, HEIDI (PTA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E VALLEY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8304
Mailing Address - Country:US
Mailing Address - Phone:970-927-9319
Mailing Address - Fax:970-927-0168
Practice Address - Street 1:1450 E VALLEY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8304
Practice Address - Country:US
Practice Address - Phone:970-927-9319
Practice Address - Fax:970-927-0168
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 3192225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066577Medicare Oscar/Certification