Provider Demographics
NPI:1942952007
Name:MITCHELL, BRIGITTE KING (PTA)
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:KING
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 10TH ST SW
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-6020
Mailing Address - Country:US
Mailing Address - Phone:386-234-5246
Mailing Address - Fax:
Practice Address - Street 1:3520 N CROSSING CIR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1067
Practice Address - Country:US
Practice Address - Phone:229-242-8394
Practice Address - Fax:229-242-8769
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA29717225200000X
GAPTA002577225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant