Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5501012809 | MI |
NPI | 1215247150 |
---|---|
Provider Name | Mrs. Nicole Heather Mitchell |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | North Branch, MI 48461-8144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2010 |
Last Update Date | 18/08/2015 |