Provider Demographics
NPI:1891477204
Name:MITCHELL, KYLEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 DOREY ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-2645
Mailing Address - Country:US
Mailing Address - Phone:814-761-5838
Mailing Address - Fax:
Practice Address - Street 1:650 CARNEGIE BLVD STE 220A
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-0367
Practice Address - Country:US
Practice Address - Phone:610-707-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist