Vontress Mitchell

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MAT-15259 Issued in HI

Practice address

1090 Keolu Dr Ste 104
Kailua, HI 96734-3871

Phone

(808) 262-2292

NPI assigned

Sep 9, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Pono Mitchell Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Team Physical Therapy LLC

  dba Enchanted Lake Physical Therapy

  • Physical Therapist
  • Kailua, HI
  • NPI 1942598883
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567987200000",
    "number": "1316596778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HEKILI ST # A376",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967342800",
            "telephone_number": "808-201-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 KEOLU DR STE 104",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967343871",
            "telephone_number": "808-262-2292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "VONTRESS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-09",
        "last_updated": "2019-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "HI",
            "license": "MAT-15259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PONO",
            "last_name": "MITCHELL",
            "credential": "LMT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Mind Body Medical Services FL PA
• Mindful Connections, LLC
• Mindful Matters, Inc.
• Creelyn Joy Mitchell
• Jerrie S Mitchell, LCSW
• Jenny Miyachi
• Carolyn Miyagi, LMP
• Jarin Miyamoto, PHARM D
• Pat Hiroshi Miyamura, DDS
• Mobile Hearing Care

• Massage Therapist in Kailua, HI
• Providers in Kailua, HI by specialty
• Massage Therapist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.