Provider Demographics
NPI:1053604561
Name:MITCHELL, DANIEL ELLIOTT (PT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ELLIOTT
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1151
Mailing Address - Country:US
Mailing Address - Phone:732-616-9156
Mailing Address - Fax:
Practice Address - Street 1:4 BUTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1151
Practice Address - Country:US
Practice Address - Phone:732-616-9156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00728100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist