Provider Demographics
NPI:1992738868
Name:MITCHELL, TERESA ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANN
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 1:5205 WESTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-7201
Mailing Address - Country:US
Mailing Address - Phone:812-424-2417
Mailing Address - Fax:
Practice Address - Street 1:701 N WEINBACH AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-5990
Practice Address - Country:US
Practice Address - Phone:812-479-3099
Practice Address - Fax:812-479-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001914A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000090420OtherANTHEM
IN000000090420OtherANTHEM