Provider Demographics
NPI:1891029534
Name:MITOL, JENNIFER (PT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MITOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:5114 BALCONES WOODS DR
Mailing Address - Street 2:STE 306
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5273
Mailing Address - Country:US
Mailing Address - Phone:512-372-3612
Mailing Address - Fax:512-372-3943
Practice Address - Street 1:801 E WILLIAM CANNON DR
Practice Address - Street 2:STE 225
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-6646
Practice Address - Country:US
Practice Address - Phone:512-270-2060
Practice Address - Fax:512-270-2061
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL070015897225100000X
TX1235920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist