Provider Demographics
NPI:1366576829
Name:MITCHELL, KEIR (PT)
Entity type:Individual
Prefix:MRS
First Name:KEIR
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:529 W BROMPTON AVE
Mailing Address - Street 2:UNIT 3S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6409
Mailing Address - Country:US
Mailing Address - Phone:773-883-8736
Mailing Address - Fax:312-996-1457
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:PHYSICAL THERAPY DEPARTMENT, ROOM C-100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-996-3700
Practice Address - Fax:312-996-1457
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.010938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist