Provider Demographics
NPI:1912052770
Name:MITCHELL, HELENE B (PTA)
Entity Type:Individual
Prefix:MS
First Name:HELENE
Middle Name:B
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 TOWNSEND DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-3128
Mailing Address - Country:US
Mailing Address - Phone:732-671-8781
Mailing Address - Fax:
Practice Address - Street 1:812 POOLE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-2024
Practice Address - Country:US
Practice Address - Phone:732-739-4666
Practice Address - Fax:732-739-0236
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00228100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant