Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1558769570 |
---|---|
Provider Name | Jonathan Mitchell |
First Address | Selinsgrove, PA 17870-9019 |
Second Address | Selinsgrove, PA 17870-9019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2014 |
Last Update Date | 08/12/2014 |