Provider Demographics
NPI:1679031165
Name:MITZEL, JORDAN LEE (DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEE
Last Name:MITZEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:CROOKS
Mailing Address - State:SD
Mailing Address - Zip Code:57020-0765
Mailing Address - Country:US
Mailing Address - Phone:605-360-0229
Mailing Address - Fax:
Practice Address - Street 1:2419 2ND AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-3602
Practice Address - Country:US
Practice Address - Phone:515-576-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist