Provider Demographics
NPI:1881965952
Name:MITCHELL, AIMEE M (ATC)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ROCK RD
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3301
Mailing Address - Country:US
Mailing Address - Phone:973-906-1426
Mailing Address - Fax:
Practice Address - Street 1:268 S FINLEY AVE
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1435
Practice Address - Country:US
Practice Address - Phone:908-204-2585
Practice Address - Fax:908-204-1356
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM25MT001167002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer