Healthcare Provider Details

I. General information

NPI: 1306219472
Provider Name (Legal Business Name): KELLEY DEANNE BECHERER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9350 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 855-543-0333
  • Fax: 858-657-1809
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number43240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: