Provider Demographics
NPI:1013159813
Name:MITCHEM, JOSLYN AMELIA (LPTA)
Entity Type:Individual
Prefix:MISS
First Name:JOSLYN
Middle Name:AMELIA
Last Name:MITCHEM
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9480 PRINCETON SQUARE BLVD S
Mailing Address - Street 2:APT 2414
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0302
Mailing Address - Country:US
Mailing Address - Phone:904-446-5895
Mailing Address - Fax:
Practice Address - Street 1:2802 PARENTAL HOME RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5702
Practice Address - Country:US
Practice Address - Phone:904-721-0088
Practice Address - Fax:904-721-6561
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21456225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant