Provider Demographics
NPI:1700977733
Name:MITCHELL, RONALD JOSEPH (MPT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOSEPH
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 CORNUS CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-4628
Mailing Address - Country:US
Mailing Address - Phone:856-296-3412
Mailing Address - Fax:
Practice Address - Street 1:1828 CORNUS CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-4628
Practice Address - Country:US
Practice Address - Phone:856-296-3412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00482900261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy