Provider Demographics
NPI:1972600203
Name:MITCHELL, CAROLYN M (PT)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:M
Last Name:MITCHELL
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 1:40 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2401
Mailing Address - Country:US
Mailing Address - Phone:201-818-1114
Mailing Address - Fax:
Practice Address - Street 1:1100 RT 17 NORTH
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446
Practice Address - Country:US
Practice Address - Phone:201-818-1114
Practice Address - Fax:201-327-0491
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA005333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist