Provider Demographics
NPI:1619118056
Name:MITCHELL, BRANDON JOHN (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:JOHN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:ATC
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Mailing Address - Street 1:131 DUFFY DAUGHERTY FOOTBALL BUILDING
Mailing Address - Street 2:MICHIGAN STATE ATHLETIC TRAINING
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824
Mailing Address - Country:US
Mailing Address - Phone:517-353-1655
Mailing Address - Fax:517-432-2137
Practice Address - Street 1:131 DUFFY DAUGHERTY FOOTBALL BUILDING
Practice Address - Street 2:MICHIGAN STATE ATHLETIC TRAINING
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824
Practice Address - Country:US
Practice Address - Phone:517-353-1655
Practice Address - Fax:517-432-2137
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer