Provider Demographics
NPI:1437828092
Name:MITCHELL, MADISON P (DPT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:P
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:14601 N SCOTTSDALE RD STE 108
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2984
Practice Address - Country:US
Practice Address - Phone:480-729-8400
Practice Address - Fax:480-651-8102
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZLPT-033698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist