Provider Demographics
NPI:1215109947
Name:MITCHEM, JOHN T (ATC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:MITCHEM
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 BUTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-6197
Mailing Address - Country:US
Mailing Address - Phone:540-470-0288
Mailing Address - Fax:
Practice Address - Street 1:1929 BUTTONWOOD CT
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-6197
Practice Address - Country:US
Practice Address - Phone:540-470-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260005462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0126000546OtherBOARD OF MEDICINE