Provider Demographics
NPI:1528410685
Name:MITCHELL, DENISE (PT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7975 LAKE UNDERHILL RD STE 345
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8209
Mailing Address - Country:US
Mailing Address - Phone:407-303-8626
Mailing Address - Fax:
Practice Address - Street 1:7975 LAKE UNDERHILL RD STE 345
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8209
Practice Address - Country:US
Practice Address - Phone:407-303-8626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist