Provider Demographics
NPI:1891029534
Name:MITOL, JENNIFER (PT)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MITOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 SW VETERANS WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2700
Mailing Address - Country:US
Mailing Address - Phone:541-527-4386
Mailing Address - Fax:
Practice Address - Street 1:946 SW VETERANS WAY STE 100
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2700
Practice Address - Country:US
Practice Address - Phone:541-527-4386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015897225100000X
TX1235920225100000X
OR640722251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist