Provider Demographics
NPI:1598554784
Name:LEVINE, MITCHELL DUANE (DPT, PT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:DUANE
Last Name:LEVINE
Suffix:
Gender:
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 RIVER MARSH DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4207
Mailing Address - Country:US
Mailing Address - Phone:904-923-2349
Mailing Address - Fax:
Practice Address - Street 1:100 EXECUTIVE WAY STE 109
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-2713
Practice Address - Country:US
Practice Address - Phone:904-543-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist