MEDICARE: THERESA KELLY-MITCHELL DPT, PT, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	19341	MT
2	225100000X	Physical Therapist	CP053702T	VA

General Provider Information

NPI Number	:	1447105622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA KELLY-MITCHELL DPT, PT, MPH

Provider Business Mailing Address
First Line	:	PO BOX 412307
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-2307
Country	:	US
Telephone Number	:	914-294-4050
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 B ST STE 102
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-2462
Country	:	US
Telephone Number	:	757-548-0014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/11/2026

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