Provider Demographics
NPI:1386371516
Name:STRAND, MITCHELL RICHARD (PT, DPT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:RICHARD
Last Name:STRAND
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 1:705 BREEDLOVE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2080
Mailing Address - Country:US
Mailing Address - Phone:678-635-7221
Mailing Address - Fax:678-635-7298
Practice Address - Street 1:705 BREEDLOVE DR STE 300
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2080
Practice Address - Country:US
Practice Address - Phone:678-635-7221
Practice Address - Fax:678-635-7298
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist