Provider Demographics
NPI:1912158999
Name:MITCHELL, KAYLA JO (DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JO
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:JO
Other - Last Name:MALO BUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:CANDO
Mailing Address - State:ND
Mailing Address - Zip Code:58324
Mailing Address - Country:US
Mailing Address - Phone:701-968-2541
Mailing Address - Fax:701-968-4096
Practice Address - Street 1:7448 HWY 281 N
Practice Address - Street 2:
Practice Address - City:CANDO
Practice Address - State:ND
Practice Address - Zip Code:58324
Practice Address - Country:US
Practice Address - Phone:701-968-2541
Practice Address - Fax:701-968-4096
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1463402Medicaid