Tracey Wallace Mitchell, L.P.T.A.

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2306001473 Issued in VA

Practice address

103 Rosehill Dr
South Boston, VA 24592-4843

Phone

(434) 572-4906

NPI assigned

Apr 23, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992923817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 JONES FERRY RD",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245926078",
            "telephone_number": "434-476-9630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 ROSEHILL DR",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245924843",
            "telephone_number": "434-572-4906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "TRACEY",
        "middle_name": "WALLACE",
        "credential": "L.P.T.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2306001473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victor Mihal, D.O.
• Corin Kelly Miller, FNP
• Mills Family Practice
• Amy C Mills, FNP
• Paul Alex Mitchell, PTA
• Steven Dwayne Mize
• Ashley Bowen Moore, OTR/L
• Brayden Moore, PT, DPT
• Brittany Moore
• Samantha Louise Moreno

• Physical Therapy Assistant in South Boston, VA
• Providers in South Boston, VA by specialty
• Physical Therapy Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.