Timothy W Mitchell, PT
Individual provider Active NPI Physical Therapist · Bloomindale, OH
NPI 1972806644 · NPPES record last updated Mar 2, 2012
Key facts
- NPI
- 1972806644
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 013103 (OH)
- Practice address
- 2320 County Road 25
Bloomindale, OH 43910 - Phone
- (740) 424-8243
- NPI assigned
- Dec 17, 2010
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013103 | OH | MD | Physical Therapist |
| PT021809 | PA | MD | Physical Therapist |
| 002922 | WV | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 002922 | WV | |
| Physical Therapist | 225100000X | 013103 | OH | Yes |
| Physical Therapist | 225100000X | PT021809 | PA |
Addresses
Primary practice location
2320 County Road 25
Bloomindale, OH 43910
Mailing address
2320 County Road 25
Bloomingdale, OH 43910-7789
Phone (740) 424-8243
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT002922 | Other | WV LICENSE | |
| PT013103 | Other | OHIO LICENSE |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.