Provider Demographics
NPI:1720792732
Name:MITCHELL, PATRICK THOMAS JR (LMT)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:THOMAS
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:9821 SUMMERWOOD CIR APT 1623
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5771
Mailing Address - Country:US
Mailing Address - Phone:501-399-9443
Mailing Address - Fax:
Practice Address - Street 1:9821 SUMMERWOOD CIR APT 1623
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5771
Practice Address - Country:US
Practice Address - Phone:501-399-9443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT137692225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist