Provider Demographics
NPI:1326389602
Name:MITCHELL, KELLY ANNE (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:ANNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:SPIEGELHALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MC 5068
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-5829
Mailing Address - Fax:858-966-5859
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:MC 5068
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-5829
Practice Address - Fax:858-966-5859
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208787225100000X
CA2914212251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist