Provider Demographics
NPI:1689892663
Name:MITCHELL, BRIAN CARLTON (PTA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CARLTON
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 S LINDSAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-4431
Mailing Address - Country:US
Mailing Address - Phone:405-640-7253
Mailing Address - Fax:405-721-2025
Practice Address - Street 1:6525 N MERIDIAN AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1420
Practice Address - Country:US
Practice Address - Phone:405-721-1115
Practice Address - Fax:866-721-2025
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1402171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor