Provider Demographics
NPI:1003533076
Name:OSTEOPRACTIC PHYSICAL THERAPY OF THE MIDWEST
Entity type:Organization
Organization Name:OSTEOPRACTIC PHYSICAL THERAPY OF THE MIDWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:563-321-7666
Mailing Address - Street 1:1011 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:IL
Mailing Address - Zip Code:61252-1946
Mailing Address - Country:US
Mailing Address - Phone:563-321-7666
Mailing Address - Fax:
Practice Address - Street 1:1316 17TH ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:IL
Practice Address - Zip Code:61252-2012
Practice Address - Country:US
Practice Address - Phone:563-321-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty