Provider Demographics
NPI:1821294398
Name:MITCHELL, STEFANIA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-2911
Mailing Address - Country:US
Mailing Address - Phone:516-270-3049
Mailing Address - Fax:
Practice Address - Street 1:67 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-2911
Practice Address - Country:US
Practice Address - Phone:516-270-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist