Provider Demographics
NPI:1265147565
Name:MITCHELL, JILL (PT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 GURNEYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:ME
Mailing Address - Zip Code:04862-6244
Mailing Address - Country:US
Mailing Address - Phone:207-542-3872
Mailing Address - Fax:
Practice Address - Street 1:15 STRAWBERRY AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5941
Practice Address - Country:US
Practice Address - Phone:207-777-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist