Provider Demographics
NPI:1689792798
Name:MITCHELL, JASON CHRISTOPHER (MSED, ATC, V, ATL)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MSED, ATC, V, ATL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8908 SEMMES AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-4828
Mailing Address - Country:US
Mailing Address - Phone:210-382-8214
Mailing Address - Fax:
Practice Address - Street 1:OLD DOMINION UNIVERSITY
Practice Address - Street 2:ATHLETIC ADMINISTRATION BUILDING #1113C
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23529-0001
Practice Address - Country:US
Practice Address - Phone:757-683-6462
Practice Address - Fax:757-683-5445
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT37662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer