Provider Demographics
NPI:1013143049
Name:MITCHELL, JON THOMAS (ATC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:THOMAS
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1841
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28017-1841
Mailing Address - Country:US
Mailing Address - Phone:704-406-3912
Mailing Address - Fax:704-406-3503
Practice Address - Street 1:110 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28017-9797
Practice Address - Country:US
Practice Address - Phone:704-406-3912
Practice Address - Fax:704-406-3503
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer