Provider Demographics
NPI:1104104116
Name:MITCHELL, CARRIE L (PTA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6 SAINT ANDREWS LN
Mailing Address - Street 2:
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04538-1731
Mailing Address - Country:US
Mailing Address - Phone:207-633-1982
Mailing Address - Fax:207-810-4971
Practice Address - Street 1:6 SAINT ANDREWS LN
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-1731
Practice Address - Country:US
Practice Address - Phone:207-633-1928
Practice Address - Fax:207-386-0181
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1725225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant