Provider Demographics
NPI:1386077543
Name:MITCHELL, LISA ANN (PTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 SHOAL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37329-9526
Mailing Address - Country:US
Mailing Address - Phone:423-253-7271
Mailing Address - Fax:
Practice Address - Street 1:834 SHOAL CREEK RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:TN
Practice Address - Zip Code:37329-9526
Practice Address - Country:US
Practice Address - Phone:423-253-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5181174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator