Provider Demographics
NPI:1639205065
Name:MITCHELL, CAROL ELISE (PT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ELISE
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 1:208 HARRIS RD APT JA1
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-2120
Mailing Address - Country:US
Mailing Address - Phone:914-666-8286
Mailing Address - Fax:
Practice Address - Street 1:21 PEEKSKILL HOLLOW RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3248
Practice Address - Country:US
Practice Address - Phone:845-528-3133
Practice Address - Fax:845-528-0463
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011622-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist