Provider Demographics
NPI:1700418621
Name:MCNANNA, MITCHEL ROSS (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:ROSS
Last Name:MCNANNA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LITTLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3962
Mailing Address - Country:US
Mailing Address - Phone:774-573-6132
Mailing Address - Fax:
Practice Address - Street 1:406R WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1342
Practice Address - Country:US
Practice Address - Phone:508-429-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist