Provider Demographics
NPI:1740772045
Name:MITCHELL, ALLYSON A
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9411
Mailing Address - Country:US
Mailing Address - Phone:303-478-8950
Mailing Address - Fax:303-805-0602
Practice Address - Street 1:3042 ELM AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9411
Practice Address - Country:US
Practice Address - Phone:303-478-8950
Practice Address - Fax:303-805-0602
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012549225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant