Provider Demographics
NPI:1134704521
Name:WILHOIT, MITCHELL (ATC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:WILHOIT
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 1:14904 GRAND SUMMIT BLVD APT 204
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-2772
Mailing Address - Country:US
Mailing Address - Phone:816-719-9690
Mailing Address - Fax:
Practice Address - Street 1:2300 HIGH GROVE RD
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2677
Practice Address - Country:US
Practice Address - Phone:816-316-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180242262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer