Provider Demographics
NPI:1366914798
Name:MITCHELL, ZACHARY KYLE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:KYLE
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 E ROUND GROVE RD APT 1021
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3869
Mailing Address - Country:US
Mailing Address - Phone:361-550-4443
Mailing Address - Fax:
Practice Address - Street 1:6155 SPORTS VILLAGE RD STE 400
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3578
Practice Address - Country:US
Practice Address - Phone:214-618-3246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-25
Last Update Date:2018-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1299550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist