Provider Demographics
NPI:1679362339
Name:MITCHELL, MARIELLE (DPT)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NW IRVING ST APT 728
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2261
Mailing Address - Country:US
Mailing Address - Phone:404-435-7779
Mailing Address - Fax:
Practice Address - Street 1:15640 NW LAIDLAW RD STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-3828
Practice Address - Country:US
Practice Address - Phone:503-764-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist