Provider Demographics
NPI:1912342429
Name:DEBORAH A MITCHELL PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:DEBORAH A MITCHELL PHYSICAL THERAPY, LLC
Other - Org Name:RED ROCK PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-451-4502
Mailing Address - Street 1:5435 BULL VALLEY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7434
Mailing Address - Country:US
Mailing Address - Phone:815-451-4502
Mailing Address - Fax:
Practice Address - Street 1:5435 BULL VALLEY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7434
Practice Address - Country:US
Practice Address - Phone:815-451-4502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70013347261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy